Dialogue minutes

1  Equal-Life – Deliverable 8.2 Project title: Early Environmental quality and life-course mental health effects Project Number: 874724 Project Acronym: Equal-Life Work package 8 - Deliverable D8.2 Dialogue minutes HISTORY OF CHANGES Version Publication date Change 1.0 20.12.2023 2.0 31.12.2023 final Ref. Ares(2023)8897306 - 29/12/2023 H2020 program Grant agreement numbers 874724 (Equal-Life) Project start date: Jan 1st 2020 Duration: 60 months Project Coordinator: Irene van Kamp (RIVM) WP (number and title) Equal-Life WP8 Stakeholder involvement and intervention development Deliverable Number Equal-Life D8.2 Deliverable Title Dialogue minutes Due date 31. 10. 2022 Actual date 31. 12. 2023 Dissemination Level Public Lead beneficiary INCHES Responsible author(s) and beneficiary acronym: Peter van den Hazel –INCHES, Miriam Weber – City of Utrecht, Sonja Jeram –NIJZ, Sammie Jansen – RIVM, Roos Teeuwen - TU Delft, Achilleas Psyllidis – TU Delft, Gordana Ristovska – IJZERM, Sarah Benz – ZEUS, Julia Kuhlmann – ZEUS, Anna Sandionigi – Quantia, Marco Balduini – Quantia, Dirk Schreckenberg – ZEUS, Maddie White – UB, Lena GudiMindermann – UB, Jenny Ahrens – UB Work package/task: WP8 / Task 8.1 Document status: Final Confidentiality: public Key words: Stakeholder, Co-design, forum, science-policy interface E-mail / phone responsible authors Peter van den Hazel [email protected] Miriam Weber [email protected] Co-authors Sonja Jeram [email protected] Sammie Jansen [email protected] Roos Teeuwen [email protected] Achilleas Psyllidis [email protected] Gordana Ristovska [email protected] Sarah Benz [email protected] 3  Julia Kuhlmann kuhlman[email protected] Anna Sandionigi [email protected] Marco Balduini [email protected] Dirk Schreckenberg [email protected] Maddie White [email protected] Lena Gudi-Mindermann [email protected] 4  Contents  Summary............................................................................................................................................6 Introduction.....................................................................................................................................7 WorldCafésession..........................................................................................................................9 2.1TwoonlineworldcafésessionsJanuaryandFebruary2021..................................................9 2.2Worldcafé18May2021.............................................................................................................10 2.3Worldcafé17June2021–Dutchstakeholders..........................................................................10 StakeholderforumLjubljana.........................................................................................................10 Co‐designworkshopSkopje..........................................................................................................11 StakeholderforumMilano............................................................................................................11 6.Co‐designworkshopComo............................................................................................................12 7.StakeholderforumHelsinki...........................................................................................................12 8.Partners/Equal‐Lifecontactinformation.....................................................................................14 9.Annexes.........................................................................................................................................15 Annex1TwoonlineworldcafésessionsJanuaryandFebruary2021..................................................15 Annex2Worldcafé18May2021........................................................................................................23 Annex3WorldcafésessionwithDutchStakeholders17June2021...................................................25 Annex4MentimeterquestionsandanswersstakeholderforuminLjubljana.....................................28 Annex5StakeholderforumLjubljana..................................................................................................35 Theme1:Scaleonwhichresultsshouldfocus..................................................................................35 Theme2:Includingtheimpactofenvironmentalfactorsonmentalhealthfactorsinallpolicy making...............................................................................................................................................35 Theme3:Settingupeffectiveyouthparticipation...........................................................................36 Mentalhealthplans...........................................................................................................................36 Annex6Someexamplesofusedpersonas..........................................................................................38 Annex7Co‐designworkshopinSkopje................................................................................................40 4.1Theme1:Co‐designtools......................................................................................................40 4.2Theme2:WorkingonapplicationoftoolsbasedonEqual‐liferesults................................41 4.3Theme3:Workingtowardstranslationofscientificresults.................................................41 4.4Theme4:Interventions‘bridgingthegap’asatooltoimprovehealthforall.....................43 4.5Theme5:Spectrumofprevention........................................................................................45 4.6Theme6:Whatarethenextsteps?......................................................................................46 Annex8StakeholderforumMilano......................................................................................................47 5.1Equal‐Lifehandbookandtoolbox.........................................................................................47 5  5.2WorldcafédiscussionsonEqual‐Lifepresentations.............................................................48 5.3Usingalogicmodelasatooltoencouragethinkingaboutsocialinequalitiesinurban planninginterventions......................................................................................................................56 5.4Evaluatingchildren’saccesstopublicoutdoorplayspace...................................................56 5.5Policyrecommendationperspectives...................................................................................57 5.6Spectrumofinterventions,screeningmethods,toolboxandhandbookinpractice............58 5.7Whatarethenextsteps?......................................................................................................58 Annex9Co‐designworkshopComo......................................................................................................60 Annex10StakeholderforuminHelsinki...............................................................................................66 Annex11Co‐designprocesspresentation...........................................................................................74 Annex12Workingonapplicationoftools...........................................................................................77 Annex13MentimeterresultsstakeholderforumHelsinkiSeptember2023.......................................79 Annex14researchquestionsusedinComoco‐designworkshop........................................................83 6  Summary TheEqual‐Lifeprojectaimstoinvestigatethecombinedeffectsofvariousexposuresonchildrenand adolescentmentalhealthacrossdifferentdevelopmentalstages.Importanttothisprojectisthe collaborationwithstakeholders. Thetask“Connectingsciencetopolicy”relatedtoD8.2hastheobjectivetoestablishabi‐directional dialoguebetweentheEqual‐Lifeprojectand(inter)nationalpolicymakersto1)translateproject resultsintoeffectivechildrenhealthpoliciesand2)injectknowledgeaboutbestpracticesandhealth policiesintotheproject. Thisdeliverableisareportofmeetingswithstakeholdersrepresentingthedialogueswiththose stakeholders.Therewereninedifferentmeetings.Eachmeetingwasstructuredaccordingtodifferent themes.Theworldcafésessionsweretargetedtocollectinformationfromthestakeholderstocreate ascience‐policyinterface.ThestakeholderforainLjubljana,MilanoandinHelsinkiwerestructured accordingtodifferentinteractivesessions.Differentworkingmethodswereused.Arangeofpotential outcomeswereaddressed. Theoutcomesoftheworldcafésessions,theco‐designworkshopsandstakeholderforasignifyamajor steptowarddevelopingasetofpolicyimplementations,atoolboxandguidebook.Theseoutcomes notonlyaddressthecomplexitiesofexposomedatabutalsoensuresitspracticalapplicabilityin diversesettings.Thecollaborativeandinclusivenatureofthiseffortreflectsacommitmentto advancingourunderstandingoftheexposome'simpactonchildmentalhealthandcognitive development.Thefindingsprovideafoundationforinformedpolicydecisions,promotingthe integrationofthistoolboxintorelevantresearch,healthcare,andeducationalinitiatives. Thecollectedinformationfromstakeholderscontributestogetintoaninteractivemodewith stakeholders.TheyareinterestedinpracticalimplicationsofEqual‐Liferesults.Itshouldassistthe stakeholderstounderstandtheconnectionsbetweenthemultipleresultsdisplayedandwhatthey meanforoptionsofinterventions.Forthescientificcommunity,nearnesstodecision‐makersis important.Scientistsshouldmakeuseofcommunicationexpertswereapplicableinorderto communicatetheirdataresultsandrecommendations. 7  Introduction  Thetask“Connectingsciencetopolicy”relatedtoD8.2hastheobjectivetoestablishabi‐directional dialoguebetweentheEqual‐Lifeprojectand(inter)nationalpolicymakersto1)translateprojectresults intoeffectivechildrenhealthpoliciesand2)injectknowledgeaboutbestpracticesandhealthpolicies intotheproject.Thistaskensuresthatthegeneratedknowledge(onexposome,mechanisms,and healtheffects)isdevelopedinlinewiththeneedsofthebroadersociety,andthatknowledgeofthe involved(publicandprivate)stakeholderswillhelptointerprettheresults.Thisscience‐policy interactiongivesabetterunderstandingofthesocietalimpactandrelevanceoftheEqual‐Liferesearch bothforthescientistswithintheprojectasforthestakeholders.Wehaveidentifiedkeystakeholder (policymakers,regulatorsandresearchnetworks),andsetuptwoformalco‐designworkshopand threestakeholderforaandestablishedregularinteractionbetweenscientistsandstakeholders. Thisdeliverableisinaformatofareport.Itisarepresentationofallactivitiesinninedifferent meetings.Eachmeetingwasstructuredaccordingtodifferentthemes.Thestakeholderforain Ljubljana,MilanoandinHelsinkiwerestructuredaccordingtodifferentinteractivesessions.  Worldcafésessionsin2021and2022  StakeholderforuminLjubljana,March7‐8,2022  Co‐designworkshopinSkopje,September14‐15,2022  StakeholderforuminMilan,November16‐17,2022  Co‐designworkshopinComo,June29‐30,2023  StakeholderforuminHelsinkiSeptember7‐8,2023  ThisreportreflectsonlytheminutesofthemeetingsThereisanoverlapwithD8.4.Thisreportshows moreonthepresentationsandlessontheconclusionsoftheinteractionwiththestakeholders.This sinceintheprojectproposaltherewasnotmadeacleardistinctionbetweenthemeetingsthatwere meanttobeonlytocommunicatewithstakeholdersortobemeantforinteraction.Onlytheworld cafésessionsduringthefirstprojectcouldberecognizedasapurelydialogueprocess. TheDeliverable8.2willbeupdatedagainin2024afterupcomingmeetingswithstakeholders.  Worldcafésession TheWorldCafémethodologyisasimple,effective,andflexibleformatforconductingagroupdialogue. Eachelementofthemethodhasaspecificpurposeandcorrespondstooneormoreofthedesign principles.Themethodmakesuseofaninformalcafesettingforparticipantstoexploreanissueby discussingitinsmalltablegroups.Discussionisheldinmultipleroundsof20‐30minutes,withthecafe ambianceintendedtoallowformorerelaxedandopenconversationstotakeplace.Itisamethodto quicklycollectalotofinformationasallparticipantshavetheopportunitytospeak. Co‐designworkshop Co‐designistheactofcreatinginteractionwithstakeholders(policymakers,end‐users)specifically withinadesigndevelopmentprocesstoensurethattheresultsmeettheirneedsandareusable.Its aimistocreatesomethingnotonlyforpeople,butalsowiththem.Stakeholderscanbecomecreators ofaproductbeingactivelyinvolvedinthecreationprocess.Co‐designisoftenatransdisciplinary 8  process.Theresultcanbeareportoraproduct(handbook,guideline).InEqual‐Lifetheco‐designisa tooltoenablestakeholderstouseEqual‐Liferesultsforpolicymakingoreventodraftinterventions. Weconductedoneco‐designworkshopinSkopje(seechapter3). Stakeholderforum StakeholderForummeansaplatformopentorepresentativesofinstitutions,national,regionaland localauthorities,organisedinterestsandindividualentitiesfromdifferentdomains,highereducation, research,associations,civilsocietyandclusterorganisations,aswellasotherinterestedpartiesfrom acrossaselectedknowledgeorpolicyfocus. Thesetupoftheworkprocessofco‐designworkshopsorstakeholderforumissimilar.Theforumaims moreatsendinginformationbetweentheparticipants.Theco‐designworkshopaimsatproducing contentrelatedtotheproductsthatareseenasresultoftheproject. Theprocessoftheco‐designworkshopandstakeholderforumusesastructuredapproach.This approachfacilitatesacodesignworkshop/forumaimedatcollaborativelydeveloping1)inputfor policyrecommendations;2)atoolorguidebookwithsupportfromdiversestakeholders.Theprocess emphasizesopencommunication,activeparticipation,anditerativefeedbacktoensureawell‐ roundedandinclusivefinalproduct.Thefollowingstepscanbeidentifiedandhavebeenusedatthe differentworkshopsandfora. 1.DefiningObjectivesandScope:Theworkshopbeginswithacleararticulationofitspurposeand goals.Thefocusisondefiningthescopeofthetoolorguidebook,establishingboundariestoguide thecollaborativeprocess. 2.IdentifyingStakeholders:Stakeholders,includingend‐users,subjectmatterexperts,anddecision‐ makers,areidentifiedandinvitedtoparticipate.Thegoalistoensureadiverserepresentationthat capturesabroadrangeofperspectives. 3.Pre‐workshopPreparation:Participantsreceiverelevantinformationbeforetheworkshop,along withmaterialsorresourcestoreview.Acommunicationplatformisestablishedtofacilitateongoing collaborationamongstakeholders. 4.WorkshopAgenda:Adetailedagendaoutlinestheworkshopactivities,incorporating introductions,icebreakers,andspecificdesignsessions.Timeisallocatedforbrainstorming, prototyping,andfeedbacksessions. 5.FacilitationTechniques:Facilitationtechniquesareemployedtoencourageopencommunication, activeparticipation,andequalcontribution.Thefacilitatorfostersacollaborativeandinclusive environmentwhereallvoicesareheard. 6.Brainstorming:Structuredbrainstormingsessionsareconductedtogenerateideas.Techniques suchasmindmappingoraffinitydiagramsareemployed,andparticipantsareencouragedtoshare theirperspectivesandinsights. 7.Prototyping:Thedesignisbrokendownintosmallercomponents,andparticipantsworkon creatingprototypesordraftsofthetoolorguidebook.Collaborativetoolsorphysicalmaterialsare usedtovisualizeideas. 8.IterativeFeedback:Regularfeedbacksessionsarefacilitated,allowingstakeholderstoreviewand provideinputonprototypes.Constructivecriticismisencouraged,andconcernsareaddressedto refinethedesign. 9  9.Decision‐Making:Facilitateddecision‐makingsessionshelpprioritizefeatures,content,ordesign elements.Techniqueslikedotvotingorconsensusbuildingareusedtoreachagreementsamong stakeholders. 10.Documentation:Outcomes,decisions,andchangesmadeduringtheworkshoparethoroughly documented.Aroadmaporactionplanwillcreateforthenextstepsinthedevelopmentprocess. 11.Follow‐upandImplementation:Stakeholdersarekeptinformedabouttheworkshopoutcomes. Agreed‐upondesignchangesareimplemented,andstakeholdersarecontinuouslyinvolvedinthe developmentprocess. 12.Communication:Ongoingcommunicationismaintainedwithstakeholdersthroughoutthe developmentprocess.Regularupdatesandinvolvementinfutureiterationsensuresustained collaboration. Byfollowingthesesteps,thecodesignprocessbecameadynamicandinclusivejourney,harnessing thecollectivecreativityandexpertiseofstakeholderstodevelopavaluableandwell‐receivedsteps towardspolicyimplications,atoolorguidebook. Thefollowingsectionsdescribethedifferentsessionsthatwereorganisedwithstakeholders.  WorldCafésession 2.1 TwoonlineworldcafésessionsJanuaryandFebruary2021 Method:AnonlineWorld‐Caféwashostedtocreateascience‐policyinterfaceforSouth‐Eastern Europeanstakeholderswithrelevantbackgroundstoenvironmentalresearchand/orchildren’s (mental)health.Viaqualitativecontentanalysismethods,thedataretrievedfromthe7participating stakeholderswasthematicallyanalysedandcoded. Results:Thestakeholdersincreasinglyshared,bothbeneficialandharmful,internalexposures(e.g. metabolism,microbiome,melatoninsystem,parentsage),physicalexposures(e.g.outdoorgreen‐, blue‐andedible‐spaceandplaygrounds;urbanversusruralliving;qualityofindoorandoutdoorspace includingairpollutionandnoise;lifestylefactorssuchasphysicalactivity,dietandschoolperformance medicationintake)andsocialexposures(e.g.avarietyofsocialcontactsandtheircharacteristics includingpeersandparents;theageofparentsatbirthinRomania;screentimeandlivingasedentary lifestyle;family/work‐life(im‐)balance;bicyclinglifestyle;competitivenessandawarenessaround mentalhealthinSouth‐EasternEurope;socioeconomiccircumstancesandaccesstoservices; institutionalisationinBulgaria;COVIDmeasuresandotherlegislationsandprioritiesofthe government).Mentalhealthoutcomesweredescribedthroughemotionalstatusandmediating factorswithcautionfordiagnosingchildren.Ageperiodsdiscussedwereprenatal,earlyageand adolescence. Conclusion:SoutheasternEuropeanstakeholderinvolvementcanbefacilitatedwithinascience‐policy interface,isappreciatedandcontributestospecificcountry‐basedtopics.Withinthewiderangeof internalandexternalexposuressharedbythestakeholders,socialexposuresappeartobethemain fieldofconcern.Whiletalkingaboutexposures,clusteringofmultipleexposuresoftendevelops naturally.Tobenefitchildren’smentalhealthandcognitivedevelopmentapleaforcountryspecific legislationsfollowingresearchoutcomeswasmade,preferablywithafocusonpreventiveand 16      Table 3. Harmful exposures and featuring segments identified by the stakeholders Internal Physical Social Physical activity Physical activity Outdoor space (balance safety/danger, school, learning, creativity, cleanliness) - Green space - Blue space - Edible space - Playgrounds Rural living Sound Indoor space Social contacts (unconditional love, support, feeling heard, involvement) - Parents (education, age) - Peers (sports) - Teachers - Family Screen time (learning, peer contact, gamification, social media) Economic status Government and policies Access to services - School - (Mental) health care - Child care - Violence protection - Mediation Outdoor space (peer contact) Lifestyle (family/work-life balance, bicycling) Awareness around mental health Table 4. Beneficial exposures and featuring segments identified by the stakeholders 17    Internalexposome:Thestakeholdersmentionedthe metabolismasapossibleimportantinternalexposomecomponent affectingchildren’smentalhealthandcognitivedevelopment. Itwassuggestedthatthehighmetabolicdemandofthebraininearly agescouldbeaffectedbyairpollutionandthattheeffectscouldbe measuredintheamountofoxidativestressorthroughOMICS. Furthereffectsonthemetabolismweresuggestedtobecausedby children’sdietandtheamountofphysicalactivitytheyhavebutalso inparticularbythesedentarylifestyleasaconsequenceofan increaseintheamountoftimespendbehindelectronicscreens,also knownasscreentime,inthecurrentdigitalage.Asidefromtheupcomingsedentarylifestylethe screentimealsoaffectstheamountofbluelightchildrenareexposedtoduringdaytimeandduring nighttime,especiallywhenlookedatteenagers,whichmayaffecttheirmelatoninsystemandsleep andthereforeagainalsotheirmetabolism. Anotherinternalexposomecomponentthestakeholdersmentionedwasthemicrobiome. Theriseintheanti‐vaccinemovementduringthelastdecadesisnoticed,alackofexposureandan increaseinparentsandchildrenwithfoodintolerances.Thesephenomenaareallrelatedtothe microbiomeandcouldhavepossibleeffectsonchildren’sdevelopment. Physicalexposome:Thestakeholdersreportedtheoutdoorspace,andallitcomprises,asa beneficialbutsometimesalsoharmfulpartofthephysicalandsocialexposome.Itwassaidtherehas beenalotofresearchonthebeneficialeffectsofoutdoorspaceonchildren’smentalhealthandthe importanceofcreatingoutdoorplacesnotonlyclosetochildren’slivingenvironmentsand neighbourhoodsbutalsonearkindergartensandschools.Theoutdoorplacesweresaidtohave calmingeffects,helpchildrenstayconnectedwiththerealworldandtoencouragepeercontact. Thereweremultiplerequirementsbroughtupbythestakeholderstomeettheconditionsofthe outdoorspacetobestimulatingforthementalhealthandcognitivedevelopmentsuchasstimulating tolearnwhichcanbedonethroughplay,butalsobyinvolvingchildreninpreservingtheoutdoor space;encouragingdiscoverythroughallsenses;stimulatingcreativityandimagination;cleanliness andmaintenance;tobeabletobealoneortosharethespaceandtherightbalancebetweendanger andsafety,allpotentiallybenefittingchildren’smotorskills,curiosityandworld‐image. Concerningsafety,itwassaidtobenecessarytodistinguishbetweenthesafetyofplayandthe Internalizing Externalizing Other Mediating factors Cognitive development Emotional symptoms Anxiety Trauma Depression Suicide Concentratio n problems Agitation Aggression ADHD Anti-social behaviour Health issues Eating disorders Well-being (securenes s, calmness, happiness) Resilience Stress Sleep Attachment Self-image World-image Social skills Communication skills Verbal skills (vocabulary) Motor skills Fine motor skills Digital skills School performance Intelligence Curiosity Table 5. Mental health and Cognitive development outcomes identified by the stakeholders Age categories Prenatal Early age Teenagers Table 6. Age Categories identified by the stakeholders 18  safetyoftheaccessibilitybutalsotheimportanceofnottoomuchsafetytokeepachallengewhich stimulatesdevelopment.i Thestakeholdersdefinedmultiplecomponentsthatthebeneficialoutdoorspacecouldcompriseof: Greenspacewhichcanrangefromparkstoactivelyplantingtrees;butalsospecificallyincludeedible space,greenspacethatisbeinggrowntoeat,nearchildren’slivingenvironmentsandschool environment.Bluespacecomprisingoflakes,riversandthepossibilitytoswimandplaygroundsto stimulatethecognitivedevelopmentofchildren. Thestakeholdersmentionedtheoutdoorspacebecomingaharmfulexposurewhenitistoo dangerousor(peer)conflictinducingwhichcanmakechildrenfeellesswelcomeandsafe.Thisfor examplehappenswhenthereisnotenoughspace,whenspaceispoorlymaintainedorcomprisingof toxins;toxinsinthebluespaceinparticular,becausebluespacesareoftennotdesignedwith childreninmind.Harmfuloutdoorspaceswerereportedtobeseeninareasaccommodatingmore immigrantsandhavinghigherpovertyrates.  Stakeholdersspecificallypointedoutsoundtobebothapossibleharmfulandbeneficial exposurewithintheoutdoorspaceandtheindoorspacebygivingadifferentfeelingtoinsideand outsideenvironments.Harmfulsoundisreferredtoasnoiseandisbeingseenasdisturbing, especiallyforsmallchildrenwhoarenotabletosayanythingaboutthenoise.Contrarily,sound couldalsobebeneficial,givingexamplesofnaturesoundsormusic.Noisewassaidtoaffectschool performance,topotentiallycauseconcentration,agitationandsometimesevenaggression problems.Accordingtothestakeholders,theWHOalreadyhasparticularlygoodguidelinesfornoise butduetoalackoflegislationtheyarenotbeingimplemented. Almosteverystakeholdermentionedthewidespreadproblemofairpollutionaffecting everyonefromthemomentofconceptiononwardsandpointingouttheneedofresearchofthe possibleeffectsairpollutionhasonthementalhealthandcognitivedevelopmentofchildren. SuggestingusingwearabledevicestomeasurethevolatilecompoundssuchasNOandO3peopleare reallyexposedtoandasmentionedbefore,couldhaveaneffectontheoxidativestressandOMICSin children. Thestakeholdersputforwardanextradimensiontothetopicofairpollutionandthebehaviourof peopleasareactiontoit.Adifferencehasbeennoticedincognitivedevelopmentbetweenchildren whowereraisedinurbanareascomparedtoruralareas.Statingthatchildrenofthegeneration broughtupafterthesecondworldwarweresometimesseparated.Thosewhowereraisedinurban areaswithhighereducationalopportunitiesandbetterschoolingstillperformedlessemotionally andintermsofschoolperformance,communicationskillsandverbalskillscomparedtotheir siblingsraisedinruralareaswithfewerfacilitiesbutalsolessairpollution.Evolvingthroughtime people,oftenofahighereconomicclass,arenowchoosingtomoveoutsideofthemetropolitan citiestogreenerlesspollutedareasturningthingsupsidedownespeciallyduringwintertimewhen thereappearstobeariseinburningofsolidmatterssuchasbiomass,wood,coalandtrashfor heatingpurposesduringthecoldmonthsinruralareaswithevenmoreairpollutionasa consequenceopposedtowhatismeasuredinthecity.Asidefromburningsolidmattersthe stakeholdersalsopointedoutanincreaseincaruse.Parentsareusingtheircarsmoretocrossbigger distancesbutalsobecausetheywanttoprotecttheirchildrenfrombeingoutsideinthepollutedair whilegoingtoschool.Asaresult,childrenaregettingoutofthecar,withrunningengines,when theyreachschoolsteppingintoanextrapollutedcarparkwithmorecars.Alifestylechangetowards bicyclingissuggestedtobeencouragedaspartofsolvingthecaruseproblembutevenasbeinga potentiallybeneficialexposureforchildrenonitsown. Thestakeholdersalsomentionedphysicalactivityingeneralasaprovenbeneficialexposureto 19  children’smentalhealthandcognitivedevelopmentbyimprovingemotionalsymptomsandmotor skills.TheWHOhasalreadydefinedtheamountoftimeneededforphysicalactivityinschoolperage categoryandtheimportanceofavarietyofdifferentactivities. Stakeholdersmentionedplasticasapotentialharmfulphysicalexposure,pointingoutthe dangersofmicro‐plastics,phthalateandbisphenolthatcouldpotentiallyharmchildrenevenbefore theyareborn.Theysawtheuseandwasteofplasticbottles,(food)packagingandcontainersasa problem.Itwasalsosaidthateventhoughcountriesappeartobemoreincontroloftheproblem, dangerisalwaysclosewithnewproductscomingontothemarketeveryday.  Otherpotentiallyharmfulelementsofthephysicalexposomementionedbythestakeholders were:Cigarettesmokeandsmokingbyparents,oftenveryyoungwomen,whichisstatedtobea widespreadproblemintheBalkanareaandHungary.Thiscauses(prenatal)oxygendeprivationand exposeschildrentoharmfulvolatilecompoundsinthesmoke;Pesticidesonfood,evenhaving prenataleffects;Foodadditivesandtheshortcomingincorrectlabellingoffoodinsomeofthe countriesmakingitimpossibletoaddresstheissueinascientificway;Chemicalssuchaslead, uranium,orescomingfromoldmininglocationsandthestorageofoldpesticideswhichwereused duringtheoldsocialistregimeandstillneedtobetakencareofsafely. Socialexposome:Allthestakeholdersdistinguishedsocialcontactsaspotentiallyharmfulor beneficialexposures.Whenabuse,sexualexploitationorviolenceoccurinsocialcontactsthe developmentofmentalhealthandcognitivedevelopmentproblemsispronetohappen.Onthe otherhand,stakeholdersmentionedunconditionallove,support,feelingheard,involvementinsocial contactsandparticipationinpubliclifeaspotentiallybeneficialtochildren’smentalhealthand cognitivedevelopment.“Withintheinteractionwithotherpeopleandgroupdynamicschildrenare abletolearnsocialbehaviour.”ThestakeholdersrepeatedlypointedoutthatCOVIDmeasuresputin placebythegovernmentareaffectingallthetypesofsocialcontactbyminimizingthepotentially beneficialeffectsandenlargingthenegative. Theattachmenttoandtherelationshipwithparentsinthefirstplace,butalsowithfamily,weresaid tobeproventobeofsignificantimportanceforchildren’smentalhealthandcognitivedevelopmentii andaparentandfamilystrengtheningapproachtobethebaseofallchildsupport.Parentsstruggling withaddiction,busyparentsandafamilythathasafamily/work‐lifeimbalancecouldharm children’smentalhealthandcognitivedevelopment,whilehavingasupportivefamilywitha family/work‐lifebalancecouldbenefitthechildren.Stakeholderssuggestedthatthesentimentthat life’svalueiscreatedthroughworkneedstochange,promotingareductioninthenumberofhours spentonwork,whichwouldmakeitpossibletospendmorequalitytimewithfamily.iiiStakeholders alsosaidthattheeducationofparentscouldhaveaneffectonchildren’scognitivedevelopment. Thestakeholdersspecificallypointedouttheageoftheparentsanditseffectonchildren.Where Romaniahasaveryhighrateofyoungmotherswhohavetheirfirstchildunder18italsohasahigh rateofmotherswhoarehavingtheirfirstchildaftertheageof35yearswiththehelpofinvitro fertilisation.Thisresultsinau‐shapedbirthgraphic.Theageoftheparentscouldhavegenomic effectsbutmoreimportantly,itaffectstheemotionalandculturalenvironmentchildrenarebrought upin.Havingoldparentswasdescribedasgrowingupwitha‘grandparents‐feeling’,providinga moreemotionallysafeandstableenvironmentwithlessstress,morebondingandbetter communicationmakingchildrenmoreresilientandgivingthemanadvantageincognitive developmentbystimulatingtheircommunicationskills.Whereasveryyoungmothersweresaidto oftencomefromruralareas,unprivilegedfamiliesandgypsycommunitieswithlessfinancialmeans, givingchildrenalessstableenvironmentandthereforepotentiallyharmingtheirdevelopment. 20  Thestakeholdersmentionedschool,educationalsystemsandthesocialcontactchildren havewiththeirteachersasbothpotentiallyharmfulandbeneficialexposures.Thecommon educationalsystemthatrevolvesaroundpoints,gradesandcompetitionweresaidtopressure childrenandcausestress.Accordingtothestakeholder’scompetitionhasbecomeoneofthehighest valuesinsociety.TheystatecompetitivenesstobeespeciallyhighamongstSouth‐EasternEuropeans, provokingacompetitivelifestylewhichinturncausesariseinoverdiagnosingandtheuseofschool performancemedicationasapotentiallyharmfulexposureonitsown.Stricteducationalsystems where,forexample,achildisnotallowedtousethetoiletwhentheyneedto,weresaidtobe harmfultotheirmentalhealth.Onlineeducationcouldnegativelyaffecttheirschoolperformance andsocialskillsbyalackofteacherandpeercontact,especiallytheyoungestchildren. Stakeholderspointedoutthatchildrenneedsupportfromtheirteachers,lessstressandmore freedomtoflourish. Thestakeholdersmentionedpeercontacttobeofimportanceforcognitivedevelopmentandmental health,withspecialmentioningofpeercontactthroughsportsimprovingtheirsocialskills.In contrast,itwassaidthatlackofpeercontactcouldevenhaveanegativeeffectwhichwillbefurther elaboratedinthenextsection.Conflictbetweenchildrenwasalsosaidtobepotentiallyrelatedto thedevelopmentofmentalhealthproblems. Almosteverystakeholderpointedouttheexposuretoscreensasharmful,buttheyalsosaw potentiallybeneficialeffectsscreentimecanhave.Screentimeincludedtheusageofinternet, televisionandsocialmedia. Aspreviouslymentioned,thestakeholderstouchedonscreentimeinternallyaffectingthemelatonin systemthroughbluelightexposureandaffectingthemetabolismasaconsequenceofthesedentary lifestyle.Thestakeholdersreferredtoscreensasbeingaddictiveandstimulatingasedentarylifestyle atagrowingrate.Thesedentarylifestyletogetherwiththeindoorlifestyleisevenfurtherstimulated byCOVIDmeasuresthatareimposedbygovernments.Itwasalsosaidthatthereisariseinscreen timebecauseofbusyparentsandparentswhousescreenstocontroltheirchildren,reporting18‐ month‐oldchildrenbeingabletousescreens. Anotherconcernstakeholderspointedoutwerechildrenhavinglessreal‐lifepeercontactbecauseof screentime,livinganindoorlifestyleandCOVIDmeasures.Thismakeschildrenlessableto communicatetheirfeelingsandemotionsinreallifeandaffectstheirattachment,socialskills, communicationskills,verbalskillsandvocabulary,self‐imageandworld‐image.Butinopposite screentimecouldalsohelpchildrentolearn,improvefinemotorskillsanddigitalskills,andto connectandtohavefunwithotherchildrenandparents.“Inthepastchildrenwouldhavepenpals butnowtheycaneasilyhavecontactwithchildrenallovertheworld.” Thestakeholdersalsopointedoutthatchildrencouldbecomeexposedtostereotypesonthescreens affectingtheirbehaviour.Theysuggestweshouldbelookingintothecontentthatthechildrenare watching,likingandsharingononlineplatformssuchas“TikTok”. Thestakeholdersspecificallymentionedtelevisionanditscontentbeingveryloud,colourful,overthe top,fast‐movinginan‘unnatural’wayandverydistractive,whichcouldallpossiblyaffectchildren’s mentalhealth. Thestakeholdersalsosaidthatwecouldbeusinggamificationandscreentimetopositivelyaffect children’sbehaviourbyencouragingchildrentogooutsideandlearnabouttheirenvironmentand eventopossiblybenefittheirenvironment.Pointingouttheimportanceofpeerreviewandagainthe competitivenessasastrongculturalcharacteristicinthesouth‐easternpartofEurope.Theuseof children’ssocialmediaandinfluencerswerebroughtuptoresearchthechildren.Furthermore, influencerscouldalsobeusedtopositivelyaffectthementalhealthofchildrenbecauseofthe enormousimpacttheyhaveonthem. Stakeholderssawscreentimeaffectingtheresilienceofchildren.Thisispotentiallycausedbythe 21  feasibilityoffastswitchingbetweenexposuresinthedigitalworldassoonassomethingisnotto theirliking,lackofpeerreviewandnothavingtodealwiththeemotionsandactionsofotherpeers. ItwasalsosaidthereisariseinADHDdiagnosesseenalongsidetheriseofscreenusagewhichcould becorrelated.ThestakeholdersadditionallypointedoutthattherecouldbeabiasconcerningADHD inoverdiagnosingduetothepossibilitytoreceivefundsafterbeingdiagnosedwithADHDandthe likelihoodofADHDbeingcausedbysomeprenatalexposures. Thestakeholdersindicatedthattheinternetcanalsobeusedtolearnanddevelopdigitalskillswhich wassaidtobeofimportanceinthemodernworld.However,thestakeholderswerealsoworriedthat screentimewillonlymakebrightchildrenclevereratthecostoftherest. Thestakeholderssawgovernmentandpoliciesasanessentialpartoftheexposome research.First,bypotentiallyaffectingchildren’scognitivedevelopmentandmentalhealthin positiveornegativewaysthroughrulesandlegislationssuchastheCOVIDmeasuresandgiving accesstoservices.Butsecondtothatbyaffectingwhatisdonewithalltheknowledgegained throughexposomeresearchoranyotherexposureresearch.Thestakeholdersobservedthatwhen therearenolegislationsandmandatoryeffectivepolicychanges,thegovernmentswillnotputthe obtainedknowledgeintouseevenwhentheevidenceisstrongandbackedupbytheWorldHealth OrganizationAsaresult,theykeeptheapproachtocuringinsteadofpreventingnegativehealth impactswiththesupportofpublichealth.Itwassuggestedthatguidelines,adjustedtodifferent countries,couldhelp.Theyalsoproposedthedirectinvolvementofmunicipalitiesbecausethey sometimesstillhavegoodwilltomakeachangeevenwhenitisnotmandatory. Thestakeholdersalsomentionedtheeconomicstatusofthechild’ssocialenvironmentandthe accesstoservicestobeofimpactonchildren’smentalhealthandcognitivedevelopment.Thiscan bethroughtheavailabilityofappropriatechildcare,(mental)healthcareandpsychosocialsupport, disabilitycare,schoolandeducationortheoptiontoreceivemediationorviolenceprotectionbut evensomethingsmallashavingthepossibilitytoreadabook,gooutsideandhavethepossibilityto beinaplacewheretheycanrelax,canhaveaneffect. GovernmentsinBulgariaweresaidtohavebeenviolatingchildren’srightsbyinstitutionalising childrenin‘orphanages’evenwhentheyhadparents.Theseinstituteswereportrayedasfree childcare,buttheydidnotprovideproperserviceorcare.ThisrenderedBulgariawiththehighest rateofabandonedchildreninthepastandcausesmentalhealthandcognitivedevelopmental problems. InBulgariatherehasalsobeenaproblemofincorrectdiagnosingofchildrenwithanti‐social behaviourincaseofmisdemeanourssuchasstealing,runningawayfromschoolorhome.Inthisway thechildisheldresponsibleinsteadoflookingproperlyintothecircumstanceswhicharecausingthis behaviour,whichofteninvolvelackoffamilysupportandpoverty.Theseso‐called‘statuscrime’ convictionscausechildrentobesentawayintocorrectionalinstitutesor‘socialpedagogicschools’ wheretheyoftenlearncriminalbehaviourfrompeersinsteadofbeingsupportedandreformedby theinstitutes.Throughtheyearschangeshavebeenmadeandthenumberofinstituteshasgone downbutthephilosophybehindthesystemappearsnottohavechangedandtheproblemisbeing divertedintootherforms. Thestakeholdersmentionedtheimportanceofraisingawarenessaroundmentalhealthand environmentaldangersbutontheotherhandalsoemphasizedthatoverinformingonenvironmental dangerscanbecomeapotentiallyharmfulexposureonitsownbyincreasingstress.Thestakeholders pointedoutthattherestillisabigstigmaaroundmentalhealthinSouth‐EasternEuropeand reformationofmentalhealthcareisneeded.Inthismentalhealthenvironment,thereismainlyfocus ontreatingthediseaseandthereislittletonoplaceforprevention.Thestakeholdersalsoindicated thatweshouldbelookingmoreintowhatinterventionsandmethodseffectivelybenefitthechildren insteadoflookingatthediagnosetheyreceived. Mentalhealth:Thestakeholdersdescribedthementalillnessoutcomesastheemotional statusofachildorthewayachildisemotionallyperforming.Otherinternalizingoutcomesthe 22  stakeholdersreferredtowereanxietyandtraumawhichwassaidtobeapresent‐dayproblemoften causedbyviolenceandabuseandwithnopropersupportcouldleadtodepressionorevensuicide. Asidefromthepreviousmentionedconcentration,agitation,aggressionandADHDoutcomesno otherexternalizingsymptomswerebroughtupbythestakeholders. Furthermore,thestakeholderstoucheduponthewell‐beingofchildrenincludinghappiness, calmnessandsecureness,eatingdisordersandthepossibilityofmentalhealthissuesappearingas otherhealthissues. Agecategories:Multiplestakeholdersemphasizedthattheywouldliketoseemoreresearch ontheenvironmentalexposuresduringtheearlyage,orfirst1000days,andonteenagersand referredtotheprenatalageinthepreviousspecifiedsituations.  23  Annex2Worldcafé18May2021  Participants:Dimitri(D),Licia(Li),Ana(A),Laura(L). Threequestionswereaddressedinthissession. 1) Theinternal,externalandsocialexposuresyouconsideraspotentiallyharmfulto children’smentalhealthandcognitivedevelopment. D:traumaticeventsinthefamilyenvironment;theparentsaresometimesalsovictimsofthe situation.It’shardtoprotectchildreninsuchsituations[e.g.whenthere’snoclearabusebythe parents],andtheseproblemsstartinearlylife. Li:worksonaresearchprojectaboutkids/teenagersthattakecareofparents,thesecaring responsibilitiesareariskfactorforfuturementalhealthproblems,butitcanalsohaveapositive effect.Thesechildrenshouldbesupportedtomitigatetherisksandhelpthemenhancethepossible positiveeffectsoftheircaregiving. A:inchildrenwithchronicdiabetes,traumaticeventssuchasalotofstressisariskfactor.Thefamily environmentcaninfluencetheirmentalhealthinbothpositiveandnegativeways.These parents/familiesandchildrenshouldbeempoweredtodealwiththesituation. D:caringforfamilymemberscanalsobepartoftheeducationandidentityofchildren,itcanalso helpthemcopewiththeirmentalhealthproblemsortraumas.Mentalhealthisincreasinglylinkedto physicaldiseasesviaepigeneticmechanisms.He’sperforming[orhasperformed?]ameta‐analysis onbiomarkersindepression;thesebiologicalindicatorsaren’tlookedintomuchwhensignaling mentalhealthproblemsbutcanindicateearlysignsofmentalhealthproblems,earlierthan psychologists/healthprofessionalscandetectssigns. L:manyfactorsareinterrelated,forexamplebiomarkersofstresscanbelinkedtoSESfactors,and there’smultiplecausesforthisrelation.There’strendtocollectmoredata,butthatcanleadto problemsdistinguishingthetreesfromtheforest,it’sgoodtohaveaclearfocusinresearchandnot justcollecthugeamountsofdata. D:agreeswiththistrendforbigdata;butit’sdifficulttocombinedifferent[treatment?]approaches inoneanalysis,forexampleinFranceit’shardtogetfundingforstudyingcombinedapproaches whenthecomponentshavealreadybeenstudiedseparately.Toovercomethesefundingdifficulties anetworkmeta‐analysiscanbeanoption,thisusespooledinformationfromdifferentapproaches. Qualitativeanalysesarealsoincreasinglyperformed. 2) Theinternal,externalandsocialexposuresthatyouconsideraspotentiallybeneficial tochildren’smentalhealthandcognitivedevelopment. A:contactwithpeersandotherfamiliesthatdealwithsimilarissuesandsituationscanhavea positiveeffectonmentalhealthindiabeteschildrenandtheirfamilies.It’seasiertoconnecttopeers thantohealthprofessionalsandthiswaypromotesempowerment.HerorganizationinPortugalis organizingsummercampsthatareremarkablysuccessful:childrenfeellesslonely,andtheylearn frompeershowtodeal/copewiththeirdisease.Theyalsoorganizemeetings/coursesforfamiliesto shareexperiencesandlearnsfromeachother. 24  Li:forchildcaregiversitcanbegoodtobuildrelationswithothersignificantothers,notthesick parentsorfamilymembersinvolvedinthecaregiving,butforexampleteacherscanplayasignificant role,thiscanhelpcopingwiththesituationandpreventmentalhealthissues. L:controllabilityisalsoakeyfactor;tohavesomedegreeofcontrol,feelingsofhelplessnessandlack ofcontrolcannegativelyinfluencementalhealth.Childrenshouldgooutsideandexperiencethat theiractionsdosomethingintheworld. Li:givingchildrenandtheirfamilyinformationaboutthediseaseandsituationcanincreasetheir senseofcontrol. D:ineducationmorepsychologicalandscientificinsights/theoriesshouldbeappliedtoimprovethe schoolenvironment,childrenshouldlearnhowtousetoolsandgainskillsinsteadofsittingstillall day,thiswaytheycanlearnhowtobeincontrolandtoberesponsible L:there’sbeenstudiesthatshowthatgreenspacecanbebeneficialforthemicrobiome;USA researchmeasuredpeople’sgeolocations,andfoundthatmorediverseenvironmentswasrelatedto bettermoods A:physicalactivitycanhavebiological(physical),behavioralandmentalhealthbenefits.Routineand aschedulearealsoparticularlyimportantindealingwitha[chronicdiabetes]disease. 3) Thementalhealthproblemsandcognitivedevelopmentaldisordersinchildrenthat youobservebeingaffectedbyallexposuresandthechildrenaffectedbythese exposures.  Compilationofanswers: ‐ Anxiety,depression,behavioralissues,riskonaddictionlaterinlife ‐ Microinflammatorystatus. ‐ There’sathinlinebetweenwhatisconsideredtobeadiseaseandwhat’snot– there’sagreyarea. ‐ L.mentionedresearchdomaincriteriainitiativeasanalternativetotheDSMcriteria –itconsidersbiomarkersofpsychopathologywhereastheDSMisbasedon psychologicalquestionnaires. ‐ Botharedebatableandhaveprosandcons.  25  Annex3WorldcafésessionwithDutchStakeholders17June2021  Therewerethreeparticipantsattheonlinesession.TheywerefromtheNetherlands. Threethemeswereaddressedinthissession. Theme1‐Theinternal,externalandsocialexposuresyouconsideraspotentiallyharmfultochildren’s mentalhealthandcognitivedevelopment. Theme2–Theinternal,externalandsocialexposuresthatyouconsideraspotentiallybeneficialto children’smentalhealthandcognitivedevelopment. Theme3–Thementalhealthproblemsandcognitivedevelopmentaldisordersinchildrenthatyou observebeingaffectedbyallexposuresandthechildrenaffectedbytheseexposures. Participants:EvelieneD.(ED),Karin(KB),EmilyM.(EM) Theme1‐Theinternal,externalandsocialexposuresyouconsideraspotentiallyharmfultochildren’s mentalhealthandcognitivedevelopment. ED–roleofparents,productionoffood(packagingmaterials),breastfeedingcanbeaprotective factoragainstobesity,butmuchhasbeenresearchedaboutnutrition.Butthebreedinggroundin whichproductsareproducedisalsointeresting. Stressorsincertaingroups–lowSES,poverty,reducedskills Airqualitycanalsoplayarole. KB–highlyeducatedparentsalsohavestress. EM–lowSEShasoftenbeenlikethisformanygenerations,acrossgenerationsisinteresting.Agingis astressfactor,apartfromSESetc.Sodon'tjustkeepaneyeonlowSESgroups,everyparentcan haveabackpackthataffectsthedevelopmentofthechild. KB–forfood,alsoviewpackagingmaterial. EM–lackofexerciseaffectsbraindevelopment–andthatinfluencesfuturegenerations. Moderator:whatismeasuredinyourfieldintermsof(bio)markers? ED:toolittle KB–welookatthemanifestationsofthat,anxietydisorder,panicetc.[lookingattheeffectside] EM–iftherearebehaviouralproblems,welookbackatwhatwent'wrong'inearlylife,butwhat non‐medicalfactorsandsignallinginstrumentsarenowslowlybeingdone. RD–thefamilysituationisalreadybeinglookedat(context) ED–anditalsolooksatchildcareandthecontextthere. KB–gooddevelopment:midwivescanalreadyidentifywhethermother/familyarevulnerable(broad definition),thenyouthnursecanvisitthefamilytoseewhatmakesthefamilyvulnerableandhelpis thenoffered. Peter:EQLwantstosetupinterventions–couldwecontinuetotalkabouthowthatcouldbefitted intoprenatalscreeninginthecomingyears? 32  Session: Bringing all countries in Europe at a higher level of science and policy making 33  34  35  Annex5StakeholderforumLjubljana  Theme1:Scaleonwhichresultsshouldfocus  Thefirstdiscussionswereaboutonwhatscale(neighbourhood,city,country,etc.)theresultsofthe Equal‐Liferesearchshouldfocus,andwhetherafocusshouldbeplacedondeprivedneighbourhoods. Theoverallconclusionwasthatineachcountrythedecision‐makingpowerandfinancesareona differentscale,andthatdataareoftenonlyrelevantiftheysaysomethingaboutthatscale.Anexample fromSloveniawasthatabenchmarkhadbeendevelopedinwhichregionsarecomparedwitheach other.However,theseregionsarenotdecisiveentitiesanddonotmanagetheirownfinances,thus theresultsofthisbenchmarkwerenotusedforanything.Itwassuggestedtodeterminescalesthat aretranslatabletoeachcountry(e.g.pieceofstreetsegment,urbanblock,neighbourhood,district, city,region,etc.)andtofocus/classifyresultsonthesescales. Someadditionalobservationsfromparticipants:  Multi‐levelmodel;interventionsonalllevelsshouldfeedintoeachother.  Evaluationsofeffectivenessaremissing;whatdointerventionsachieve?  Socialdimensionandcognitivedimensionareveryimportant;verydifferentformentalhealth (vs.physical)  Itiseasierforpeopletoreflectonphysicalratherthanmentalhealth.  Exposomeresearchiscomplex&multidimensional;interventionsonvariouslevelsare necessary.  Exampleofintervention:https://young.scot/  Practicalaspects:needofstakeholdersthatresearchdeliverspracticaloutputs;aretheresearchers awareofstakeholderneeds?Howtoinvolvestakeholdersinthenext(research)steps?Matching Equal‐Lifeworkwithstakeholders(needs).Eveniftheyareawareoftheirneeds,theymaynotbeable tohelp.Forexample,dataneededarenotavailableatthelevelthatwouldallowanalysis.Forexample, dataonhealth/wellbeingareonlyavailableformunicipalitiesinSlovenia.Thosedonotallowstudies atneighbourhoodlevelforexample.MaybeEnvironmentalAtlascanbepromotedassourceofatleast someinformationontheenvironment.Thisisavailableatleastforsomeexamplesforthelocallevel. ForexamplenoisemapsareavailableatneighbourhoodlevelbutonlyforareasdefinedinDirective 2002/49/EC.http://gis.arso.gov.si/atlasokolja/profile.aspx?id=Atlas_Okolja_AXL@Arso  Theme2:Includingtheimpactofenvironmentalfactorsonmentalhealthfactorsinall policymaking  ThisconversationstartedwiththequestionofwhetherEnvironmentalImpactAssessmentsare necessaryforeffectivepolicymaking. Theenvironmentwasbroadlydefinedtoalsoincludee.g.socialmedia,climatechange,fearofwar, availabilityofspacetoplay,etc.Itwasmentionedthatthemostrelevantaspecthereisthe'experience 36  oftheenvironment',insteadoftheobjectivedesignoftheenvironment.Groupscontinuedtodiscuss whatittakestoincludementalhealthandcognitivedevelopmentasafactorinallpolicyfields. Impedingfactorsthatwerementionedincludedifficultiesofworkingtogetherinaninterdisciplinary way,uncertainty/unwillingnesstolookbeyondyourownpolicyfield,notspeakingthesamelanguage, and'lackofmentalhealthliteracy'.Itwasalsomentionedthattoofewevaluationsarecarriedouton theeffectivenessofinitiatives,makingitdifficulttoconvincepolicyofficers/politiciansthattheirpolicy areahassomethingtodowithmentalhealth.Thecomplexityoftheconceptofmentalhealth(and interventionsrelatedtoit)wasmentionedasapossiblefactortoconnectpolicyfields:thetopicisso complexandversatilethateveryone'sinputisusefulandnecessary.Clientandcitizen participation/citizens'initiatives(speakingfromtheexperienceofthecitizeninwhichallsectorscome togethernaturally)werealsomentionedasaconnectingfactorbetweenfields.  Theme3:Settingupeffectiveyouthparticipation  Inthelastround,wediscussedhowabottom‐upapproach,withtheparticipationofyoungpeopleand childreninresearchandpolicymakingcanbestbesetup.Theplayfulparadigmandthe15‐minutecity werementionedasgoodexamples.Itwasdiscussedthatitisdifficulttoreacharepresentativegroup ofyoungpeople.Finlandworkswithayouthportal,inwhichyoungpeopleareaskedquestionsabout policyplans.Alinktothesequestionsissharedinseveralwaysviasocialmedia,withextraeffortbeing putintoengaginggroupsofyoungpeoplewhoareoutofthepicture–forexampleviaDiscord discussionplatformsandTikTok.Theimportanceoftrainingchildrenandyoungpeopleinpolicy participation(forexampleatschool),givingthemtheconfidencethattheirinputcounts,andimproving theinvolvementoflessprivilegedchildren/youngpeoplewasalsodiscussed.Asagoodexample,it wasmentionedhowchildreninCanadaareencouragedfromprimaryschooltospeakpubliclyandto bepoliticallyengaged. Finally,aparticipantfromScotlandtalkedabouthowlegislatingthechildren'srighttoinvolvementin policymakingopeneddoorstodevelopingapproachestobeeffectiveinyouthparticipation. Supplement:AnothergoodexampleistheBundesjugendvertretung(FederalYouthCouncil,BVJ)in Austriawhichisthe“legallyanchoredrepresentationoftheinterestsofallchildrenandyoungpeople inAustria”(https://bjv.at/english‐information/).  Mentalhealthplans Wecollectedmentalhealthplans(withafocusonchildren)togetagriponsomeoftheissuesthat stakeholdersarefacingintheirwork. Mentalhealthpolicyplansmentionedduringtheforum:  InSlovenia,NorthMacedonia,butnotspecificforchildren.SeeforSloveniae.g.: https://www.nijz.si/sl/publikacije/mira‐za‐dusevno‐zdravje‐nacionalni‐program‐dusevnega‐ zdravja  Croatia:nationalplanforchildren,howevernotaddressingthesettings,physical environment.Addressinghealthandeducation.Mentalhealthliteracyandhealthyliving programmeswithfocusandfinancialresourcesforgreenareas. 37   Dutchprogramme‘Kansrijkestart’.https://www.kansrijkestartnl.nl/  Developmentalprogrammeandsupportforteachersetc.needed(inAustria)  Scandinaviafirstthousand‐dayprojectreports:https://norden.diva‐ portal.org/smash/get/diva2:1571297/FULLTEXT01.pdf; https://www.norden.org/en/publication/first‐1000‐days‐nordic‐countries‐situation‐analysis; https://norden.diva‐portal.org/smash/record.jsf?pid=diva2%3A1640984&dswid=‐296  Theseplanshavebeenusedintheworkshopsandstakeholdersforaasexamplesofinspirationand ofidentificationofproblemsinthedomainofchildmentalhealthandcognitivedevelopment.  38  Annex6Someexamplesofusedpersonas 39   40  Annex7Co‐designworkshopinSkopje  Theworkshopwasstructuredaccordingtodifferentthemes.Eachthemewasintroducedbyoneofthe Equal‐Lifepartners. Weuseddescriptionsofpersonasofdifferentkindofstakeholdersintheworkshop.Thepurposeof personasistocreatereliableandrealisticrepresentationsofakeyaudience.Theserepresentations shouldbebasedonqualitativeandsomequantitativeuserresearch.Wewantedtogetsomeinsight ofwhatkindofstakeholdersarerelevantforcooperationwithresearcherswithintheEqual‐Life project.Notallpossiblestakeholderswerepresent.Theknowledgeofwhichstakeholderswerenot presentisalsorelevantinformation.Wemustconsiderhowtoreachouttothosemissingstakeholders. Someexamplesofthedifferentpersonasthathavebeendevelopedbytheparticipantsareaddedin theannex6. Afterawelcomeandageneralintroduction,wediscussedthedifferentpersonasandstakeholder representationoftheparticipants.Thiswasfollowedbysessionsaccordingtodifferentthemes.  4.1Theme1:Co‐designtools  ThissessionwasintroducedbyPvdH(INCHES).Thesessionaddressedquestionsonhowtowork towardsimplementationofresultsofEqual‐Lifeintohealthandenvironmentalpoliciesconsidering childrenandyouth.Whichco‐designtoolsareavailable?Whatcanwelearnfromdifferentexamples? Whichtoolscouldbenefityourwork? Theworkingmethodwasaworldcafésetupwith4groupsand4questions(4x15minutes).This roundtablediscussedthefollowingquestions:  Doyouhaveexperienceandlessonslearnedregardingco‐designorotherparticipatory approaches?Doyouuseco‐designinyourwork?Doyouuseco‐designinyourwork,inyour organisation?  Doyoucollaboratewithotherprofessionals,withscientists,withcitizens?  Doyouneedtoshiftpolicies,projectsand/orbudgetstochildren’smentalhealthandcognitive development?  Doyouhavetipsregardingimplementingnewtools,new(scientific)evidenceinyour organisation,yourwork?  Themainconsiderationsweregroupedaccordingtothetopics:1)co‐designprocess;2)awareness raising;3)co‐designtools;and4)cooperation.Theparticipantsgaveabroadrangeofsuggestions. Co‐designingprocess:Learningfromandlisteningtostakeholdersneedinvestment,fromthestart, withoutpresumptions.Non‐linearprocess,sometimesyouneedtogobacktoprevioussteps.Listen topeoplethatarenotenthusiastic.Havepeopleinthecentreofthisprocess,forexampleas‘idea generators’.Considerrewardingstakeholders.Stresstheadvantagesofco‐design,withoutmentioning theconceptofco‐designingexplicitly.Andoutputs/resultsofsuchprocessesarenotsetatthe beginningofthe(co‐design)process. 41  Awarenessraising:weneedgoodstoriesandgood‘storytellers’tobringthetopictothepublicandto politicians.Positivestories,tailoredtoregionsandcountries(culturespecific).Shifttoprevention approach(policiesandfunding).Morelong‐termandstructuralprojects(programmes)areneeded. Thereisstillastigmainvariouscountries.Citizens(voters)canpleadforashifttopreventionwiththe politicians. Tools:importanttoknowthetargetgroup,tailor‐madeproducts.Bestpractices.Issuesaremoneyand staffing.VariousexamplessuchasLifelines,ondatacollection.Visualandinteractive.Specifythe (governmental)levelthatisaddressed.Communication,films,storytelling,etc..Toolsforpresenting data.Donotwastealotoftimefornoreason. Cooperation:Adistinctionneedstobemadebetweenpoliticiansandadministrationwithin governments.Considerwhoisincharge,whichinfluencestheresultsofthecollaboration.Theonesin chargedefinetheagenda,theexpectedoutcomesetcetera.Differentchannelsforcollaboration,see participationladder.However,eventheone‐waycommunication(loweststep)isdifficult.Peopleusing TikTokdonotwanttoreadscientificinformation.Twitter,withscientificinformation,isnotusedby ‘thepeople’.Thusconsiderthesocialmediasourceforcommunication.Collectinformationfrom differentexperts/perspectivesandcombinethatinthecommunication.Makesuccessvisible,which mightbedifferentfordifferentstakeholders.Andidentify‘whataresuccessesforthesedifferent stakeholdergroupsfromthebeginning.  4.2Theme2:WorkingonapplicationoftoolsbasedonEqual‐liferesults  Thissessiontheparticipantsdiscussedquestionssuchas:Whattoolssuitthedifferentstakeholders? Howflexibleshouldwebeinapplyingdifferenttools?Howaboutvisualization?  Feedbackwasgivenondataandonstructureofthetoolbox/demonstrator.Thelattermust befurtherdeveloped.Inspreading/disseminatingthetoolweneedtoconsiderlanguage. Nextstepistoselectthe‘datathemes’andthendetailthe(levelandtypeof)data(needs).  Datavisualisation:tipwasgiventolookattheexampleoftheDutch“Kansenkaart.nl”(see https://kansenkaart.nl/klasouderslaaginkomen#6.47/52.29/5.285)  DatainthetoolboxwillbebothfromEqual‐Lifeandfromotherexistingsources.Thedifferent WPswilldeliveralgorithmsandfunctions,andprobablynotdata.Wedonotexpect anonymiseddata.Butaggregationofdatawouldbefeasible.  Seepresentationinannex11.  4.3Theme3:Workingtowardstranslationofscientificresults  Duringthissession,theparticipantsdiscussedquestionssuchas:Howeasytounderstandneedthe resultsbe?Dowehavedisconnectionsbetweenscientistsandpolicymakers?Whatarebarriers?We usedapresentationandgroupdiscussion.Thepresentationwasfocusedontippingpointsofsocial behaviourandadoptionofchangeinbehaviourbypeople.Seepresentationinannex12. Summaryoffeedbackgiven. 48  asdeliverables,researchquestions,andfeaturesconsideredintheanalysis.Stronginterestwasalso expressedinexplanationsandtrainingonanalysismethodsandsoftwaredevelopedduringthe project,withconsequentinterestindedicatedtrainingsessions.  5.2WorldcafédiscussionsonEqual‐Lifepresentations  Presenter:MK,UniversityofKaiserslautern,CognitiveandDevelopmentalPsychology(online) Titlepresentation:Effectsofenvironmentalexposuresonmentalhealth,well‐being,andcognitionin childrenatthetransitionfromkindergartentoprimaryschool:Conceptofalongitudinalfieldstudy Worldcaféquestions:  Westudytherelationshipbetweengreenspace,noise,airpollution,socialfactors,andthe cognitivedevelopmentofchildrenintheperiodbetweenpreschoolandprimaryschool.  Fromaninterventionperspectivewhatassociationstoanalysewouldbeofmostinterestfor you Worldcafédiscussion: Thepresentationwasregardedasverygood,partlyabithardtounderstand(particularlythedifferent outcomemeasurementsandhowtheyarerelatedtoeachother).Butthestudypresentedwas regardedasquiteillustrativeaboutwhatEqual‐Lifeisdealingwithandisbettertounderstandthan thecohortdata. Topics/discussionpointsmentionedwere:  Identifyqualityaspectsofgreenspacethatareimportanttochildren'sdevelopmentandhow theyrelatetothepreferencesoftheirparents.  Greenspacesinresidentialareasaremostimportantforsmallchildren.  Studytherelationbetweengreenspaces&qualityoftimespentinthosespaces. Atthatpoint,thegroupdiscussedwhatdefinesthebeneficialqualityofgreenspaces(orotherplaces) inrelationtothementalhealthofchildren.ItwasmentionedthattheWP5definitionof"timespent" and"frequencyspent"isprobablyagoodindicatorforanenvironmentbeneficial/attractivefor children‐betterthandefining"highquality"intermsofthephysicalfeatures(vegetation,water…). "Greenspaceneedsmaintenance"wasmentionedhere. ThemoderatorsmentionedthatthePreschoolstudyisalsointerestedinsocialexposure/factors.The groupdiscussion,therefore,shiftedtowardstheroleofgreenspacefordifferent(socio‐economic) targetgroups. Topicsmentionedherebygroup1andthefollowinggroupswere:  IsthereadifferenceintheeffectofgreenspacebetweendifferentSESgroups?  Ideaforanintervention:addgreenspacetoschools.SchoolyarditselfisanequalizerofSES differences.  Thisprovidesequityofaccesstogreenspaceforpupils. Moregeneralideasforinterventionfollowed: 49   Interventionshouldprovideequityinarchitecture&urbandesign.  Bringnatureinsidethe(artificial)citytowardcreativity.  Also,animalsbringnaturebacktothecity,notthestandardelementsmorecreative.  Considerthedidacticaspectsofgreenenvironment.  Designinganinterventionthatislocatedinagreenspace(freeschoollunchinaparkduring summer–Helsinki)=>provideshealth‐beneficialeffectsofgreenspaceandequitytodifferent socio‐economicgroups. Besidesgreenspace,somegroups’memberssuggestedconsideringotherexposuresinthepreschool study,namely:  Includedigitalexposome.  Impactofelectromagneticradiationonpreschoolchildren.  Alsoincludenoise.  Presenter:CG,CentreforCognitiveScienceTUKaiserslauternGermany(online) Titlepresentation:CausalpathmodellinginEqual‐Life.Whathasbeenandwhatwillbedone?  Worldcaféquestion: Howshould(complex)empiricalandstatisticalresultsbecommunicatedtothetargetaudience,and howtopresenttheseresults,toavoidmisconceptions?  Worldcafédiscussion: Stakeholdersdiscussedthattheanswerdependsonwhothetargetaudienceisandthatthereare diverselevelsofinformationthatcanbediscussed.Thestakeholdersexpressedinterestininformation onwhattheresultsrepresentandhowtolinkittointerventionsandpractice.Itisimportanttoinform onthecontextoftheresults–whatquestionswereasked,whatdataandmethodswereused,what datawasmissing,andhowwastheconclusionreached.Itisalsoimportantforthestakeholdersto knowhowtheycanchangetheoutcomesintherealworld.Regardingtheformofpresentingresults, severalformswerementioned:short(written)summaries,interactivesessionswithstakeholders, cartoonsoranimations,andinteractiveonlinematerials.Theresultsmustbeintroducedproperly, communicatedinauser‐friendlyandsimpleway,andtherelevancetothetargetaudienceshouldbe clear.  Presenter:AP,TUDelft,theNetherlands Titlepresentation:Newmethodologicalapproachestomeasuringthephysicalenvironment  Worldcaféquestions: Whatmetrics/indicatorsareyouusinginyourdailypractice(ifatall)toassessaneighbourhood’s walkability/accessibility/encouragementofactivetravelbehaviour,etc.?Whatislacking? Doyouuseanyavailabletools/designguidelinesfromglobalorganizationssuchasWHO,UNHabitat, etc.?Whichones?Whatislacking? Whenitcomestoimprovingchildren’smentalhealthandwell‐being,whichenvironmentalaspectsdo youconsiderthemostimportantandwhy?Onwhatevidencedoyouprioritizethem? Doyouseeanypotentialintheworkwepresentedforyourdailypractice?Whatwouldyouneedto makethishappen? 50   Worldcafédiscussion: Allparticipantsagreedthatthepresentationwasverygood.Alreadyknowingaboutthiskindof researchisan“eye‐opener”.Membersofthisgroupdiscussionwereimpressedwithalldatagathered andwereinterestedinhowtheycanreachdataatasimilarlevelfortheircases.Theywouldbe interestedinreadingreportsandpublicationstoreadmoreaboutitontheEqual‐Lifewebsite. Regardingthetopic“greenareas”theysuggestedtoaddalsolocationsofschools/kindergartens,and playgrounds.Apartfromthefactthatgreenareasarediscusseditisalsoimportantwhatsuchareas offer,whatareactivitiessupportedinsuchplaces(recreation,useofdigitalapps…).Itwassuggested thatalistofaspectsthatspatialplannersshouldconsiderbeforedecidingonnewinterventions. Plannersneedactiveengagementofseveralstakeholdersincludingresidentsandfeedbackfromusers. Itisimportanttomonitorandevaluatetheuseofthegreenareaandmakeimprovementswithtime. Itisimportanttoknowwhatkindofgreenareasweneedinthecity(safety,activities…).Accessibility isimportant,needtoavoidbarriersorcrossthem(railways…).Itshouldbeadynamicprocess.Tools formunicipalitiesareneededtoconsiderthelistofaspectsthattheyshouldconsider.  Presenter:JA&LG,UniversityofBremen,Germany Titlepresentation:SocialExposome‐Concept,applicationfields,andimplications  Worldcaféquestions:  Doesourresearchinspireanypracticalimplicationsinyourwork?  Doyouseeanyoptionstointegrateourresearchinyourwork?  Doyouseeanygaps,whichshouldbeaddressedinourresearch?  Worldcafédiscussion: Doyouseeanygaps,whichshouldbeaddressedinourresearch?  OneimportantaspectwithinSocialExposomeshouldbedigitalizationandsocialmedia:Social realityishighlydigitalized,andtheincreasingglobaldigitalizationshouldbeconsideredwhen werefertothesocialenvironment,becauseofthehighinterrelatednessbetweentherealand thevirtual/digitalworlds. o Socialrealityistypicallyperceivedthrough‘digitalfilters’(i.e.useofsmartphones,iPads, socialmedia,etc.) o Theomnipresenceofdigitaldevicesdistractsfromtherealworldandinfluencesour relationships:distraction,lossoffocus(e.g.parentsandlittlechildrenparental investment) o Interactioneffectsbetweentheuseofdigitaladviceandsocioeconomic/educational backgrounddigitalliteracyisneeded.   WhentalkingabouttheSocialExposomewealsoneedtoconsidercommunityandsocial interactionsattheneighbourhood/districtlevel.  o Qualityofneighbourhoodsdiffersalotwithincitiesanddependshighlyonmovementor employmentpatterns. o Whatcanbeobservedisthatsegregationiswantedbytheprivileged residents/communities: 51  ImportantHowtobreakthroughthisaversionandincreasetolerance/opennessto achieveregenerationwithoutlosingbenefits? o Youngfamiliestypicallyareaconstantinneighbourhoodsmaybeincreaseexchange platformsforchildrentoreachacceptancebetweendiversepopulationsinsight& exchangeoflivingpatterns. o Lookforoptionstoincreasecommunityinvolvement(participatoryapproach)   Whentalkingaboutsocialinteractionsweneedtodefinethemeaningofsocialinteractions: qualityandquantityofinteractions. o Inpracticeinteractionsoutsidespecificsettings(e.g.school)definetheatmospherefor meaning,becausehereinteractionslosetheirfunctionas“socialroles”(e.g.teacher,pupil) butcangrowinto‘true’relationships.Thus,to‘improve’interactions,weneedtocreate exchangeoptionsoutsidesettings.Thisunderstandingmayalsohelptoimprove neighbourhoods/relationswithinneighbourhoods.  Formentalhealthsocialinteractionsareofhighrelevance,asweneedtoconsiderboth, perceptionofinteractionsandbehaviourwithininteractions. o Toimprovecommunities/neighbourhoodsweneedmoneyand,thus,weneedtoconvince policyanddecision‐makers,weneedtobeoutcome‐related.Butawarenessisalsohighly importantwhichalsocanbeoutcomerelated.  Doyouseeanyoptionstointegrateourresearchintoyourwork?  Qualityofdata:Concreteoperationalizationoptionsneedtobedefinedtocollectgood&clean datatodrawvalidconclusions.  Reductionofcomplexitytomakeitfeasibleinthefield–concreteguidelineswouldhelp. o E.g.LogicModelforEquityAssessment:nameconcreteevaluationcriteriathataretobe followedinthedevelopmentofinterventions.  Presenter:MD,TUEindhoven,theNetherlands Titlepresentation:Definingrelevantsettingsbytime‐activity‐soundexposuremapping.  Worldcaféquestions:  Couldyouseethistypeofstudybeingdoneinyourmunicipalityoranotherscaleyouare dealingwithinyourdailywork(neighbourhood/city/province/country)?  Doyouseeanybenefittoapplyourresearchinyourdailywork?  Knowingthetypesofdatawecollected,whatresearchquestionscometomind?(Inother words,canyougiveanyadditions/suggestionstoourwork?)  Worldcafédiscussions: Stakeholdersfoundtheideaofusingbehaviouralpatternsfordatacollectionaninterestingapproach. Theopinionsweredividedonwhethertheyseethisstudybeingrepeatedintheirownfieldofwork, duetocostsorprivacy.Theinformationthatthestakeholdersthoughtoftobebeneficialfortheirwork were:SES–noise,qualityoflife–noise,mentalhealth–noise,andthesocialdifferences.Itwas suggestedbythestakeholderstoexploretherelationshipbetweendurationandnoise,withthe questionbeing:arelocationswithahighernoiseexposurevisitedforashortertime?Othersuggestions weretoconnectmoredatatotheexistingdatasettoinvestigatethemediationofotherexposures 52  suchasgreenspaceandairqualityandtoincorporatesubjectivesoundexperienceinthefuture. Finally,thestakeholderswouldliketoseesuggestionsforinterventions,guidelinesforwhenasetting is“good”or“bad”andhowtoinformparentsandteachersbetterabouttheeffectsofnoise.   Presenter:DK,JožefStefanInstitute,DepartmentofEnvironmentalSciences,Ljubljana,Slovenia Titlepresentation:Children's(mental)healthandparticipatoryresearch:diversityoflevelsofinclusion  Worldcaféquestions:  Howtotranslatefindingsresultingfromvariousparticipatory/CSactivitiesininterventions?  Whichtools(andtheirfeatures)aretobeusedforeffectiveengagementofchildren‐alsoto fostermotivationandconsequentlysustainabilityofactivities?  Isthereroomforintegrationofapproachedpresentedintoschoolcurriculum?  Howtoassessimpactofactivities/interventionconsideringspecificsofparticipants(children) involved?  Howtofostertheupscalingoftheresultsandtheiruptakebypolicyanddecisionmakers?  Worldcafédiscussion: Inthebeginningofthediscussion,someoneaskedforanexplanationonwhatisintervention.The meaningofthewordisnotsufficientlyclear.Discussionwentindirectionthatresultsfromtheresearch areveryoftennotimplementedinpolicies.Decisionmakerslistenattheresultscomingfromresearch, buttheydonotconsidertheseresultsindecisionmaking.Weagreethatenvironmentalsensorsforair pollutionandnoiseexposurecangiveveryvaluabledataandtheyshouldbesharedwithlocal authorities.Peoplearescepticalofimplementingsolutionsonchildren’sscience. Onthetopic‐Whichtools(andtheirfeatures)aretobeusedforeffectiveengagementofchildren‐ alsotofostermotivationandconsequentlysustainabilityofactivities,theparticipantsgavevery interestingproposals.Thesetoolscouldbegames,toolsasamusementforchildren,toolsthatmake childrenresponsibletouse,butstill,theyarenotobligatoryforchildren.Itisalsoimportanttoinvolve teachersandchildren,teacherscouldmakeratingfortheirdevelopmentespeciallyindevelopmentof emotionalskills.Someofthesetoolscouldbeincludedineducationprocessandbecomepartof educationcurriculum,especiallyforenvironmentalpollutionandhumanhealth. Weshouldthinktoincludechildrenintheprocessofdevelopmentoftools—co‐creationandco‐design withchildren. Someonegaveideafordevelopmentofapplicationfordailydiary,sowecangetpicturefortime activitypatterns.  Howtofostertheupscalingoftheresultsandtheiruptakebypolicyanddecisionmakers? Forthisquestion,allparticipantswereveryscepticalthatresultswillbeimplementedinthepolicies.  Presenter:KB,senioradvisorchild&adolescentpublichealth,theNetherlands Titlepresentation:MentalHealthintheDutchPublicHealthsector  Worldcaféquestions:  Areyoumissingitemsinthewishlist? o Well‐beingasabasicconditionatschool o Moretargetgroup‐orientedinterventions o Moreaccessibleinterventions;morepreventiveinterventions 53  o Attentiontosocialandphysicalfactorsinrelationtomentalhealth o Dataabout:‐youngadults;‐migrants;‐lowsocio‐economicstatus o Morequalitativedatainthefieldofmentalhealth.  Aretherealreadyqualitativedataaboutmentalhealththatyouwouldsuggest?  Whichqualitativedataaremostrelevant?  Aretherealreadynationalresearchagenda’sMentalHealthonchildren’smentalhealth?  CanEqual‐Lifebeofanysupport?  Worldcafédiscussion: Consideringthetime,nodiscussionwasheldonKarin’spresentation.  Presenter:ES,CityofHelsinki,Finland Titlepresentation:Implementingevidence‐basedpsychosocialinterventions:anexamplefrom Helsinki,Finland  Worldcaféquestions:  Whatkindofnationalguidanceisofferedinyourfieldofwork?  Howwouldyouapplyyourexperiencesinourwork?  Worldcafédiscussion: First,timewastakentoanswerquestionsabouttheIPC‐Aintervention.Forexample,questionsabout theFinnishhealthcaresysteminwhichbasichealthcaretochildrenisprovidedthroughtheschool system,andthattheIPC‐Aisanindividualinterventionthatcanbeprovidedbyanyonewhohas completedthetraining.AnimportantquestionforEmmaishowtogetmanagersintheschooland healthcaresystemtoadopttheIPC‐Aintervention.Theinterventionisalreadyinthenational guidelines;however,thisnationalguidanceisnotenforced.BarriersinFinlandarethatmanagersdo notfeelthatimplementinghealthcareinterventionsispartoftheirjobdescription,asthelawismore focusedonpreventionthaninterventions. Afewexperiencesfromothercountrieswiththisissuewereshared:oneparticipantproposedto informparentsabouttheimportanceofthisinterventionsothattheywillaskschoolstoimplementit. AGermanparticipantproposedtostartscreeningformentalhealthproblemstoshowthemagnitude oftheproblemandcreatemoresupportforimplementingIPC‐Aorotherinterventions.Another Germanparticipantsuggestedthatitmighthelptoconvinceinsurersthattheinterventioniscost‐ efficient,theymightthenlobbyfortheinterventioninschoolsandhealthcaresettings.Aparticipant fromItalyproposedthatitmighthelptoinformuniversitystudentsabouttheimportanceofthis interventionandtheimportancetoworkinterdisciplinary,sothattheymightchangetheeducational andhealthcaresystemsofthefutureandwillseethevalueoftheseinterventionswhentheyenter professionallife.InSloveniatheyencountersimilardifficultiesinimplementinginterventions,their barriersaremainlyalackofresources,people,andmotivation,andwhohastheresponsibilityforthe implementationofinterventionsisnotclear.  Presenter:MW,NCJ,theNetherlands Titlepresentation:Yourbrainincontrol?!Universalpreventiontowardsmentalhealthinadolescents  Worldcaféquestions: 54  IsthereawayinwhichEqual‐Lifecanhelpmeasuringthechangesweaimforwiththisinterventionat school?  weexpecttoseemoreinteractionbetweenstudents,outsideclassesandlunchbreaks.  weexpecttoseemoreinteractionbetweenstudentsandteachers,outsidescheduledclasses, withoutself‐reportedresearch. Inthesequelofthefirstquestion:WherecanEqual‐lifehelptogetinsightsofchangeofbehaviourby lookingfromanotherangletothesituation?Inmostresearchongroupsandstudenttherearelotsof ethicaldiscussions.There’sanon‐ethicalpartinEqual‐Lifethatcanbehelpful.  Worldcafédiscussion: The‘Yourbrainincontrol’programislookingfor(new)waystoevaluatetheeffectsoftheintervention. Aswithotheruniversalpreventionprogramsprovidingevidenceonasingle,specificinterventionis challenging.Amethodcouldbetousesocialmediaand–inthiscase–YouTubevideosandposted commentstotrack,analyseandclassify‘thesentiments’(suggestionof/supportbyQUANTIA). Anotherquestionfromtheprogramiswhetherthisinterventionhelpsinimprovingandenhancingthe socialenvironmentofschools.Willschoolsbea‘bettersetting’,asresearchedbyEqual‐Life,dueto thisintervention?CanEqual‐Lifeprovideindicationsorcausalrelationsonsocialenvironments,school settings,andchildren’smentalhealththatwouldsupportthis?  Presenter:LG,CorkCity,Ireland Titlepresentation:Let’splayCork  Worldcaféquestions:  Barrierstoamoreplayfulcityincludededicatedfull‐timeresourcing,annualmulti‐stakeholder budgetingandpublicliability/insurancecosts.BenefitsofapplyinganyresultfromEqual‐Life inyourdailywork:researchfindingsthatproperlyclarifytheimportanceofearlypreventative interventions.Appliedresearchprojectsthattestthesefindingswouldbeagreatbenefit.  InmypresentationIwillfocuson2Corkexamples‐Let’sPlayCork(PlayfulParadigm)andLet’s GrowTogether(InfantandChildhoodPartnership).It’importanttonote:Buyinforamore playfulcityisalwayseasy–butthereisaneedformoreappliedresearchandcommittedpilot projectstogrowconfidenceintheabilitytodeliverlarger/morepermanentplayfulcity projects.  Worldcafédiscussion:  Themainchallengesaremaintenanceoftheplaygroundsandlong‐termfunding.Collaboration betweendifferentsectorsanddepartments,andpeoplewithdifferentexpertisearenecessary forfurtherdevelopment.Thatisagoodreasonforeachcitytohaveahealthycitycoordinator whowillcoordinateallofthem.Someonementionedthatchildrenneeddigitalequipmentfor playingintheplaygrounds,thiscouldbeaveryinnovativeidea.  Especiallyimportantistoconsiderequityprinciplestoavoidenlargingthegapamongdifferent populationgroups.Lorcanthinkstheyconsideredsocialinequalitieswhentheyplanned playgrounds.  Afestivalofintegratedinvolvementofchildren,parents,andotheradultsisaninteresting eventandimportantforemotionalconnection.ThiseventwasorganizedinEstonia,theyare notsofrequentlyorganized,buttheycanbeagoodexampleofinterpersonalconnection. 55   EvaluationofthisinterventioninCorkcitywasnotperformed,butLorcanthinksthatpeople aremostlysatisfied.Therewasaproposalforevaluationoftheinterventionwithwalking interviews,likewalkingthroughthecityandaskingpeoplewhattheythinkandwhatwillthey changeoraddsomethingelse.  Someonementionedasagoodexample“playfulbenchesinNewZeeland”;benchesinthe greenareas,withdifferentpossibilitiesforplayingandstimulationofchildren’sdevelopment.  Presenter:ISE,UrbanPlanningInstituteoftheRepublicofSlovenia Titlepresentation:Greenspacesforhealthierchildrenandyouth:recommendationsfrom“GoingOut forHealth”programmeinSlovenia  Worldcaféquestions:  What“additional”argumentationtosupportgreenspaceplanninganddesigninpracticecan yougive?  Howcanthequalityofoutdoorlivingenvironmentaffectandimprovethemental(and physical)healthofchildrenandyouth.  Whatkindofindicatorscanbeusedtomeasurethat?  Worldcafédiscussion:  Questionsthatcameupinthediscussionwerewhatthedefinitionsareof‘nature’and‘green space’,andthatdefinitionsprobablydifferindifferentsettings.Weshouldinvolvecitizensin defininggreenspacesandwhatqualitiestheyappreciateinthem.  Stakeholdersalsowantmoreinsightsintohowpeoplereacttodifferenttypesofgreenspaces: whatdopeoplelikeandhowisitbeneficialtothem?  Itisimportanttohavegreenspacesclosetohomesandschoolsandontherouteschildren taketoschool,thereisnotenoughdataonthisyet.  Introducedigitaltoolsforplayingreenspaces.  Presenter:UB,SocialProtectionInstituteoftheRepublicofSlovenia Titlepresentation:Isitallaboutlocation?SpatialInequalitiesinthecityofLjubljana  Worldcaféquestions  Whatisthepolicyrelevanceandapplicabilityofhighlighteddata?  Arepolicymakersandpoliticaldecision‐makersinterestedintheresults?  Worldcafédiscussion:  Onequestionwasiftherearemoreinequalitiesbetweentheareas,e.g.:Aretheremore facilitiesingeneralintheaffluentareas?Isthisquantifiableforfutureanalysis?  Itwassuggestedtolinkthenoiseexposuredata(e.g.,frompubliclyavailablenoisemaps)to thedataonkindergartensubsidiesandseeiftherearedifferencesinnoiseexposure dependingontheprosperitystatus.  Weagreedthatitisaninnovativeapproachtoestimatetheprosperityofaneighbourhood anditcouldbeconsideredtouseinEqual‐Lifeaswell.  56  KeynotepresentationSD(online) Thefirst1000daysintheNordicCountries  Thefirstmonthsandyearsofchildren’slivesareparamountfortheirfuturewell‐being.Brain developmentisatitspeakandfoundationsarelaidforneuralpathwaysandbrainregionsthatdictate futurelearning,language,emotionregulation,andbehaviour.Thislaysthefoundationforgoodmental healththroughoutthelifespan. Thefirst1000daysintheNordicCountriesisathree‐yearNordicco‐operationprojectlaunchedin 2019.IthasbeenworkingonanextensivesituationanalysisoftheNordiccountries,reviewingthe evidence‐baseforinterventionsandassessmenttools,anddevelopmentofpolicyrecommendations. Thisresultedinthreeextensivereportsonthesethreepillars. Formoreinformationsee:www.first1000days.is/about‐the‐project  5.3Usingalogicmodelasatooltoencouragethinkingaboutsocialinequalitiesin urbanplanninginterventions  ForthisworkshopsessionranbyJennyAhrens(UB),thegoalwastoevaluatetheapplicabilityofthe LogicModelforEquityAssessmentusinganexemplaryinterventiononbicycleinfrastructurebasedon theworkshopparticipants’expertise.Todothis,fivegroupswereformed,andeachgroupfocussed onthethreemainpartsofanintervention:Planning–Implementation–Evaluation. Duringthediscussion,thefollowingthreequestionswereourguidingquestions:  Whattoolssimilartothelogicmodelareyoucurrentlyusingatwork(e.g.,guidingquestions, frameworks,othermodels)?  Canyouseethelogicmodelbeingusedinyourwork?  Whatcouldbeaddedorchangedtomakethelogicmodelamoreusefultool? Asforthedifferentthreephases,itwasnotedthatanimpactassessmentwouldbevaluablewithin theplanningphaseandthatevaluationneedstobeimplementedwithinallphases. ThemaintakeawayfromthediscussionwithstakeholdersandmembersofEqual‐Lifewasthatitneeds tobemadenoticeablyclearthatthisLogicModelforEquityAssessmentisnotanotherprocess‐model butisaboutassessingtheequityaspectsinthethreemainphasesofanintervention.Ideastoimprove thiswastoemphasizethiseveninthevisualmodelbyusing“triggerwords”.  5.4Evaluatingchildren’saccesstopublicoutdoorplayspace  InthesessiononEvaluatingChildren’sAccesstoPublicOutdoorPlaySpace,RTandAP(TUDelft) collectedknowledgefromtheEqual‐Lifestakeholdersinaninteractiveworkshopsession.TUDelftaims tomeasurechildren’saccesstoplayspacesincities,tobeusedfortheenrichmentoftheEqual‐Life cohortandschoolstudydatasets.Thegoalofthissessionwasthreefold:tocollaborativelyidentifythe factorsthatlimitorpromotechildren’saccesstoplayspace;toconnectthesefactorstoelementsin 57  theurbanenvironment;andtoassessthelatestwork‐in‐progressapproachofTUDelftinmeasuring children’saccesstoplayspace. First,RTintroducedthetopictothestakeholdersandprovidedthemwithabriefoverviewofthe theorythattheworkshopwasbuiltupon.Then,stakeholderswereaskedtocontributewith suggestionsoffactorsthatlimitorthatpromotechildren’saccesstoplayspaceaskeywords,followed byabriefplenarydiscussionofthemostprevalentlimiting(i.e.,lackofsafetyorsecurity,traffic,and lackofplacessuitingageormultiplegenerationsofusers)andpromotingfactors(i.e.,safety,other children,informalplacestoplay,andequipmentforchildrenwithreducedabilities). Second,bothstakeholdersandEqual‐Lifeparticipantssplitinto6groups,eachattheirowntable,to discusschildren’saccessibilityinaspecificurbancase:3tablesfocusedonLjubljana,Slovenia,and3 tablesonMilan,Italy.ParticipantsfamiliarwitheitherMilanorLjubljanawerepresentedwiththe correspondingcity,whileotherswerespreadovertablestoensurevarietyinexpertiseand geographicalbackground.Ateachtable,anEqual‐Lifemoderatorguidedtheprocess.Participants discussedphotosandmapsofthecityathandandpinpointedwhatcouldlimitorpromotechildrento accessplayspaces. Third,participantswerepresentedwithamapoverlayontopofthemapofthesecondround,made byTUDelfttomodelchildren’saccesstoplayspace.Specifically,theseoverlaysshowedplacesthey identifiedthatmayattractchildren’splay(i.e.,playgroundsandsmallparks),orthatmaybeabarrier tochildrenwhowanttoaccessaspacetoplayinthecity(i.e.,transportandnaturalinfrastructures). Participantsdiscussedtowhatextenttheyagreedwiththebarriersandplacespresentedonthemaps, aswellaswhatshouldbeomittedoraddedtobetterreflectpractice. Throughoutthesecondandthirdrounds,participantscontributedtheirknowledgebymeansof annotations,drawings,andstickynotes.Participantsalsoelaboratedonexperiencesfromtheirown lifeortown,whichwerecapturedinaudiorecordings.TUDelftwillusethesetounderstandthe potentialandlimitationsofusingsuchdatatomodelchildren’saccesstoplayspaceintheEqual‐Life project. Preliminarytake‐awaymessagesfromtheparticipantstoRTandAPinclude:Thesizeandshapeof parks,timeofday,movementtrajectories,andsurroundinglanduseandactivitiesmatterwhen assessingchildren’saccesstoplayspace;Goodqualityinfrastructureisimportant;Andknowledge fromlocalexpertsorchildreniscrucialtogetacompleteunderstandingofchildren’saccesstopublic outdoorplayspaceintheurbanenvironmentathand.  5.5Policyrecommendationperspectives  PvdHintroducedthesessionwithashortpresentationontheecologicaldoughnutmodelandthe DPSIRmodel.ThedoughnutmodelbyKateRaworth(2012)isavisualframeworkforsustainable development,combiningtheconceptofplanetaryboundarieswiththecomplementaryconceptof socialboundaries.TheDPSIRmodel(drivers,pressures,state,impact,andresponsemodelof intervention)isacausalframeworkfordescribingtheinteractionsbetweensocietyandthe environment. 64  SessiononDataandharmonizationpresentedbyJennySelander(KI) Apresentationwasgivenonmappingofexistingcontentinthecohortsandharmonization(protocol) andcodebook. ThereareAnalysisteamson:diagnosisteam(mentalhealth),internalizing/externalizing(mental health),cognition,well‐being,andonbiomarkers.Selectionoflifephasewhereoutcomesare(most) relevant. Analysisplan: - Whichresidential(maternal)physicalandsocialexposuresduringpregnancyareassociated withADHDdiagnosis? - Whichresidentialphysicalandsocialexposuresatage0‐3yearsareassociatedwithanADHD diagnosis? - WhatistheassociationbetweenprenatalphysicalandsocialexposomeandanADHD diagnosis?Towhatextentisthisassociationmediatedbypretermbirth/SGA/LBW? - Whatistheassociationbetweenphysicalandsocialexposomeatage0‐3yearsandanAHDH diagnosis?Towhatextentisthisassociationmediatedbystress/sleep(measuredatage0‐3 year)? - Whichresidential(maternal)physicalandsocialexposuresduringpregnancyareassociated withautismdiagnosis? - Whichresidentialphysicalandsocialexposuresatage0‐3yearsoldareassociatedwithan autismdiagnosis? - Whatistheassociationbetweenprenatalphysicalandsocialexposomeandanautism diagnosis? - Whatistheassociationbetweenphysicalandsocialexposomeatage0‐3yearsandan autismdiagnosis?Towhatextentisthisassociationmediatedbystress/sleep(measuredat age0‐3years)?  Stakeholders’roleparticularlyrelevantandvaluableininterpretingtheanalysisoutcomes.Move awayfromstatisticsintointerpretation(RIVM‐IrenevanKamp). Addingdata:inEHENcontext–oritsfollow‐up(proposalfornewEUproject:I‐EHEN).  InteractivesessiononPrioritisingdata(categories) Wewantedtoknowwhichcategoriesofdataareimportantintheviewofstakeholders.Different categoriesofdatawerementioned.Prioritisedcategoriesarementalhealth,fluidintelligence,socio‐ demographicfactors,psychosocialstress,relationshipsandsocialsupport,educationalmobility, healthcharacteristics,learningandteachingconditions,livingconditions. Althoughallhave(some)importance. Reflectionsonthis‘exercise’: - Weshouldhavedonethisatthestartoftheresearchproject. - Combiningresearchandpractitioners’arguments–interdisciplinaryapproach - Combinetheseprioritieswiththeresearchquestionspriorities.  SessiononConceptualmodellingwithsemantictechnologies(Quantia,MB) 65  WithinEqual‐Lifeasemanticknowledgesearchtoolwillbedeveloped:atooltohelpyoufindinga specificdocument.Whatisanontology?Amodelof(someaspectof)theworld.Introducesvocabulary relevanttothedomain.Specifiesmeaning(semantics)ofterms.Formalisedusingsuitablelogic.Shared amongmultipleorganisations. Creatingclasses.Creatingsubclasses.Creatingaclassinstance.Forexample:artistisaclass.Painter andsculptoraresubclassesoftheartistclass.AndLeonardoisapainter(hence,alsoan artist).Leonardoisnotaclass.Andthencreatingadditionalclassinstances:forexample,DaVinci,age, birthdate.Creatingclassinstancesthroughclassproperties,forexample:Leonardopaintsthe Monalisa(painting),MichelangelopaintstheSistineChapel(painting),MichelangelosculptstheDavid (sculpture).AndthenanAItoolcanknowthatLeonardocreatestheMonalisaorthatMichelangelo createstheSistineChapelandtheDavid. Stakeholderhelpneededtoimprove/reflectonthetool. Feedbackstakeholders:searchtheevidenceandbestpractice,taketheoryandimplementthat.Not interestedinwhatisatthebackofthat(website,tooletc).Techniqueversuscontent. Searchengineoptimisation.ConceptualmodelofEqual‐Lifeistheontologyforthetoolprototype.To bevalidatedbystakeholders(e.g.instakeholderforuminHelsinki).HaveapractitionerandITexpert workingsidebyside. Organisingtheinputforthemachinelearningisamajorstep.IvK:note,therearemoreconceptual modelsinEqual‐Life,thusneedtousethedefinitiondocuments/goalayerdeeper.Suggestion: prepareanexampletofurtherdiscuss/pre‐testwithstakeholders.Startingpointfortheontology couldbetheconceptualmodelofWP1. Finalconclusion: ADemonstratorversionofthetoolbox/handbookwaspreparedandreviewedwithstakeholdersatthe WP8co‐creationmeetinginComo.Additionally,anEditorialBoardwasformedtoorganizeand incorporateresultsandfindingsfromtheEqual‐Lifeprojectintothetoolboxandhandbook.Thisboard, adoptingatop‐downapproach,comprisesmemberswithdiverseexpertiseinareassuchastoolsand training,knowledgemanagement,handbookandtoolboxdevelopment,stakeholderexpertise,and communicationandcoordination.Theirgoalistomaketheproject'soutcomeseasilyunderstandable andrelevanttothepublic.  66  Annex10StakeholderforuminHelsinki  Thursday7thSeptember ThemeetingstartedwithaconciseexplanationofEqual‐Liferesearch,theconceptualframeworkand theprogramofthe2‐dayworkshopsorganizedbyWP8(stakeholderinvolvement)andWP9(toolbox andtraining). Theconceptualframework:thetotalityofinternal,socialandphysicalexposures,overalifetime,to betterunderstandthecausesofandprocessesrelatedtomentalhealthandcognitivefunctioning,with potentialmediatingpathways,providingapossibilityforinterventionsalongthelifecourse. Expectedresults:earlylifeexposuretourbanplanningrelatedfactors(noise,air),socialfactors (parentalstress,socialeconomic),biomarkersrelatedtoenvironmentalandsocialexposures.  Presentation:Overviewofpreliminaryresults/updates(DS,Zeus) AimofWP1(onmechanisms)istoformulatetheoriesandmechanisms,forhowexposomelinksto mentalhealthandcognitivedevelopmentofchildrenandadolescentsandtounderstandhowstress/ restoration,self‐regulation/copingandsleepmayaffecttheserelationships. Researchquestionsarestudiedin‐depthinsleepandpre‐schoolstudiesandinthecohortstudies (data),enrichedwithnewdata.Examplesofdataavailableinthecohortsand/orareillustrated. Reflectionsfromstakeholders:coping,digitalenvironmentanddaylightare(yet)missinginresearch. Outcomesinfluencetheexposome;thatarrow/linkis‘missing’intheconceptualframework.Thiscan bemodelledthough(inWP7).  Presentation:Measuringaccesstopublicspaces(TUD) Thisworkshopconsistedoftwoparts. Part1:Inthefirstpart,weexaminewhichfactorsinfluencepedestrianaccesstopublicspaces andforwhom.Usinganinteractivecardgame,wewillprioritizevariedfactorsthataffectpedestrian accessibilityanddiscusshowwecanpracticallymeasurethem. Part2:Inthissecondpartwefocusonhowtoassesschildren’saccesstogreenspaceinthecity asaplacetoplay,socialize,beactive,andsoon,ultimatelycontributingtohealthyurban environments.Usinginteractivetools,wewillcollaboratetocreateidealmetricsforchildren’saccess togreenspaceanddiscussseveralmetricsthathavebeenimplementedbyTUDsofar. Relatedtopart1:SDGs,target7:by2030provideuniversalaccesstosafe,inclusiveandaccessible, greenandpublicspacesinparticularforwomenandchildren,olderpersonsandpersonswith disabilities.Howtoidentify,assess,establish/maintaintheseareas?Groupworkonwhatfactorsand forwhom?Andonmeasuringgreenspace. Identifyingandprioritizingurbanfactors:overlapinfactors,importanceofproximity,shadow,safety, lightandamenities.Mostimportantfactorsaretraffic,safety,followedbyenvironmentalfactors, green,shade.Attractivenessandaccessibilityarekey.Otherfactorsmentionedareseasonofthe year,availabilityoftime,education/practice/norms. 67  Mostimportantfactorsoftenarehardtomeasure,whereasthoselessimportantareeasierto measure.Forexample:whatis‘safety’,howtomeasurethis? Reprioritizingspecificallyforparticularpopulationgroups: - forelderlynewfactorswereidentifiedsuchasfreepublictransport,ice‐freeroutes. - forchildrenaswellnewfactorswereidentifiedsuchaspeers,distancefromhome, sidewalks/bikelanes. - forwomennotmanychangesoccurred - forpersonswithdisabilities:accessibilityismostimportantforthisgroup,aswellas safetransport.  Relatedtopart2: Measuringgreenspaceforprimaryschoolagedchildren.Whatinformationwouldyouneed?For example,geographicalsizeanddetail,atneighbourhoodleveland/ornationallevel? Suggestions:addingwearablesinordertocollectdatafromchildren’smovements,addingchildren’s voiceandperceptionongoodenvironments.Anotherpresentationwasoncyclingtowork,addingdata onprivateandpublicland,affordability,subsidizedtravelinformation,bicyclestorageandseasonal maps.Andanotheridea:“Let’splayandmovemoreoutside”,aschildrenarenotgettingoutside anymore.Avarietyofpublicplacesandincreasedattractiveness,voiceofparentsandofchildren.And planandmeasurewiththechildren. TUDelftproposals: - children’sindependentaccesstogreenspace.Itisgoodforchildrentogooutdoors independently;cantheyreacha(green)spacetoplaywithoutcrossingbarriers? - daytodaygreenspaces.Childrengotoschooleveryday,butwhichstreetsdothey passandhowvegetatedarethose? - crowd‐sourcedperceivedgreenspaces.Aredataongreenspaces,suchas OpenStreetMapandsatelliteimages,complete?Ordotheymissgreenspaces?  Improvementsuggestions:(social)safetyofplayareas,attractivenessofstreets,addchildren’svoice, useofblackspaceandwhythesearenotused(yet).  Presentationonenrichingtheenvironmentalexposome:roadtrafficflowpredictionandnoise modelling(ULEIC) Roadtrafficnoisere‐modellingandincludingincohortstudies(whereneeded).Europeanstandard modellingmethod(CNOSSOS‐EU)isusedtocalculatenoiseexposuresatfacadesofdwellings(and indirectlyofindividuals)frommainroads.Inepidemiologicalstudiesweneedexposuredatafor smaller/minorroads,forindividualdwellings,andthusthisapproachaccordingtotheEnvironmental NoiseDirective(END)isnotideal.Equal‐Lifeistryingtofillinthesegapsbyusingstatisticalmethods withaselectednumberofvariables(theso‐calledgeneralizedlinearmixedeffectsregressionmodel). Suchasroadtype,averagedailytrafficcount,population,numberofterminal/dead‐endroads, nearestmajorroadjunction,gradientoftheroad,connectivitytootherroadtypes,numberofpeople thatcandrivewithin5minutestoaparticularlocation/drivetime.Roadtrafficflowpredictionshave beentestedinUK,Barcelona;nowusedfor3Dnoisemodelling. 68  Questions:Whatistheinfluenceofelectricvehicles?Whataboutlownoiseemissionzones?Dominant sourceandbackgroundnoisedifferperroadtype,thusataresidentialroadyouwillhearrollingnoise whereasatamajorroadthatwillbeenginenoise. Nodataontrees(canopies)isincludedinthemodelling.Mostchallengingisthetemporalaspect (andthusdata)ofroadtraffic.  Socialexposome(NIJZ) Startingpointbeforethepresentationwasthedescriptionoftwomaintoolsforthetoolbox/handbook plannedfromWP4: 1)Forthetargetgroupofresearchers:ConceptualFrameworkoftheSocialExposomeandits implicationsforresearch.Abriefintroductionwasgiven,theconceptualframeworkisalready published(Gudi‐Mindermannetal.(2023).Integratingthesocialenvironmentwithanequity perspectiveintotheexposomeparadigm:AnewconceptualframeworkoftheSocialExposome. EnvironmentalResearch.DOI:https://doi.org/10.1016/j.envres.2023.116485). 2)Forthetargetgroupofpolicymakers/urbanplanners/otherstakeholders:LogicModelforEquity ImpactAssessmentanditsimplicationsforinterventionplanningandevaluation.Afterabrief introductionaCaseStudyonNoiseLegislationinSloveniawaspresented. Explanationofthesocialexposomeconceptualframework,theintegrationofphysicalandsocial exposomesandthehealthoutcomesandhealthinequalities.Tobetestedincohortstudiesandresults expectedin/aftersummer2024.Forthetargetgroupofpolicymakers,urbanplanners,publichealth authoritiesandothersisthelogicmodelforequityimpactassessment.Thisisatooltohelpembedan equityperspectiveintheplanning,implementationandevaluationprocessofuniversalinterventions toimprovethebuiltenvironment.Publicationforeseen. Suggestion:includea‘#when?’questionaswell,inadditiontoHow,Who,WhatandWhere. CasestudiesconductedinEqual‐Lifewere(i)reductionofenvironmentalnoiseexposuresinSlovenia, (ii)improvementofbicycleinfrastructureandincreaseofcyclingbehaviourinMacedonia,(iii)mobility hubsand(iv)playareasinUtrecht,theNetherlands.Theenvironmentalnoisecasestudyisfurther explained,seethehandout/ICBENconferencepaperaswell.  Discussiononconceptualframework(INCHES) Theaimofthisdiscussionwastogetapictureof:(i)what'type'ofinformationcanthedifferent stakeholdersapplyintheirwork?(ii)whichdataorresults(exposures,mediators)arerelevanttothe workofstakeholders?(iii)dostakeholdersrecognizetheirowndilemmasandquestionsthattheyhave inthefirstresultsanddeviatethisfromwhatstakeholdersexpected,intheirwork?(e.g.whatarethe maincausesandperhapsmediatorsformentalhealthinchildren,accordingtotheEqual‐Life researchersandaccordingtothestakeholders?). Aninteractivegamewasplayedtogetanideawhichkindofexposureswereprioritizedbythe stakeholders:physicalexposures,mediatorsorsocialexposures.Inaddition,stickynoteswere produced.Someoutcomeswere: Socialexposureswerehighlyratedasbeingimportant. Children’svoicesneedtobeandcanbeheard. 69  Whereismostimpacttobeexpected?Inthedecision‐makingsystems,therechangecanbe achieved.  Friday8thSeptember Casestudy:Citycollaborationtrack,Improvingyoungpeople’ssenseofsafetyinthecity(MeriVirta) BloombergandHarvardCityLeadershipInitiativesupport,inHelsinki.Publicvaluestatement:enabling asafeandwelcomingenvironmentforchildrenthroughoutthedayisgoodforeachindividualandthe community.Tacklingtheissuebybreakingitdownintosubcausesandidentifyingcomplexitiesbyan interdisciplinaryteam.E.g.lackofsafefreetimeactivitiesfortheyoung,behaviouralissuesamongthe youngatschoolandinthestreets.Growingnumberofconfrontationsbetweengroups,lackofsupport andsenseofbelongingforfamilies. Threeentrypointshavebeenselected: - Servicesaredesignedfor‘average’users o Hobbyplatform. o Co‐createserviceswithchildren. o Newarea‐basedleadershipmodel. o etc. - Lackofsafefreetimeactivitiesforyoung o Familieshaveknowledgeaboutfreetimepossibilitiesforchildren. o Proactiveleisureservicesfindyoungpeoplewithouthobbies. o etc. - Publicspaces(inclschools)areexperiencedasunsafe o Interveningandsolvingeverycaseofbullyingandharassment. o Publicspaceimprovementsandnewschoolbuildingareprioritized. o Placemakinginterventionswithchildren. o etc.  Lessonsareintegratedintoregularworkpractices. ProblemDrivenInteractiveAdaptation(PDIA)process(Harvard)steps:Initialproblemanalysis;Identify actionsteps;Takeaction;Check‐in;Sustainauthorityandlegitimacy;Adaptanditerate. Keyresultsandtakeaways: - Wemanagedtocompletenumeroussimultaneousjoinedinterventionsintheareain matterofmonths.Initialresultsindicatethatantisocialbehaviourhasdecreasedin thearea. - Startwiththeproblemandtherootcauses.Stoppingatthecommonproblemwas worththetime–thisenhancedpeople’sownershipandfromanearlystagethey startedseeingtheirroleinthesolutionstoo. - Makesureyouhavetherightpeopleatthetable.Havingthemandatetobringabout concretechangeandinterventionswascrucial. - Interventionswerebasedonwideparticipationofstakeholdersandasolid knowledgebase.  70  Qualitativedatacollection(anduse)needstobeimproved.Qualitativedatawillbecombinedwith theexisting(quantitative)datainthemunicipality.Thenadecisiononform(at)ofdatacollectionwill betaken. Whathappensnext? - Resultsarecompiledandpresentedtothecityleadership.Decisionsareyettobe madeaboutscaling. - Allcitydivisionsarecommittedtostrengtheningarea‐basedwork,utilizingthetools andprocesstrialedinthearea. - Goodworkcontinuesintheareaandsimilarworkwillbeexpandedtothe surroundingneighborhoods. - Keychallengetoaddress:thecoregroupof8peopleputalotoftimeintothisand receivedcoachingthroughouttheprocess–howdoweutilizethemethodsin existingcooperationstructures?  Casestudy:infantmentalhealth(TL‐HealthyCitiesCork) Corkcity:Let’sgrowtogether!Variousinterconnectedstrategies:infantmentalhealthandwell‐ being;speechlanguagecommunicationandliteracy.  Earlyenvironmentalquality:presentationpreliminaryresults(KI) Acombinationofbirthcohortdataanddatafromschoolstudies. FAIRcohort:ADHDmostimportantvariables(duringpregnancy)arebirthyear,income,smoking, populationdensity,roadintersectioncloseness,educationoffather,roaddistance,etc.ForAutismthe mostimportantvariablesareincome,greenurbanareas,build‐uparea,roadnoise,greenurbanarea, foreigncitizenship,etc.OtherresultsareavailablefromtheALPINE,PIAMAandWALNUTScohorts. Question:howtocommunicatetheresults? - Communicatetheresultspercohortorallpooledcohorts? - Visualizetheimportanceofthevariables.Oratoptenpresentation. - Infographic - Moreinformationisneeded,forexampleoncausality,howtointerprettherelation betweenthevariableandtheoutcome. - Involvestakeholdersinreviewingpapers!Inordertogivemeaningtoresearch outcomes.  Toolboxandhandbook(Quantia) ThestakeholderforuminHelsinkiproducedbeneficialfeedbackfortherevisedprototypeofthe toolbox/handbook. InvolvementofstakeholdersinbroadercommunicationofEqual‐Liferesultsis crucial–andoffered! DiscusseditemsfortheToolboxmodulesarestakeholders,visualization,semanticknowledge exploration,connectionandsharingmodules.InmoredetailtheStakeholdermoduleshouldbean explorativewebsitewithclickableelements.Feedbackhasbeentestedinpreviousstakeholder workshops.Theupdatedwebsiteispresentedinthisworkshopforcomments. 71  Toolsarebroadlydefined,andabroadselectionwillbepresented,butnothostedonthewebsitebut throughlinkagestothe‘owners’ofthespecifictools.Thewebsitewillbeopenforeveryoneandwill haveanexplorativepart. Usestorytelling(workshops)fortheresearchersinordertocollectstories,contentforthewebsite. Suggestions: - Insteadofawebsiteorinadditiontothewebsiteconsiderdevelopinganapp. - LinktootherwebsitesanddashboardssuchasUNICEF.   PresentationbyLAonPersonallisteningandITdevicesandtheirrelationtolifestyleofadolescentsin theSlovakRiskBehaviouralSurvey ThestudyisbasedonabilateralUS‐Slovakprojecttoevaluatetheimpactofselectedbehavioral, psychological,andsocioeconomicfactorsonadolescenthealthintheBratislavaagglomeration.Special attentionispaidtotheuseofselectedITdevices(TV,PC‐personalcomputers,personalmusicplayers ‐PMPs).Thedatafrom525students(185boys)attending8secondaryschoolsinBratislava,aged15‐ 20yearsarepresented. Themostimportanthealthriskbehaviorsinthestudents’samplewere identified,90.9%ofstudentslistentoPMPonaveragefor405minutesandusemobilephonesfor384 minutesperweek,significantlymoregirls.About50%ofstudentslistentoPMPsmorethan200 minutesaweek.ThosestudentshaveaworselifestylethanthoselisteningtoPMPslessthan200 minutesaweek.AhighpercentageofPCusagehasbeenobserved,especiallyduringtheweekend (72.1%morethanthreehoursperday),andlessinterestinwatchingTV.StudentsusethePCmore thantheirparentsandwatchlessTV,butwhenwatchingit,theycopythebehaviorofbothparents. Thestudypresentsachallengefortheanalysisandforfuturepreventionaswellasintervention activitiestoprotectandpromotethehealthofchildrenandyouth.  PlaceStandardToolforChildrenandYoungPeople(JH,cityofGlasgow) ThePlaceStandardtool(PSt)waslaunchedin2015andinresponsetoon‐goingfeedbacka versionforchildrenandyoungpeoplewasco‐producedandpublishedin2022. Thistool providesapracticalsolutiontohelpyoungercommunitiesidentifyinacollaborativeand inclusivemannerwhatworkswellwithintheirplace,whatneedsimprovingandthesolutions toaddressthese.Thetoolismadeupof14placedimensionswhichalignwiththeUNSDGs andthisrelationshipcoupledwiththesuccessfulapplicationofthetoolacrossEuropehasled toaninvitationfromWHOtoPublicHealthScotland(PHS)tohostanewCollaboratingCentre forPlacefrom2024onwards. ThelessonslearnedfromtheEqualLifeProjectwouldbe invaluablecontributiontotheCollaboratingCentre’sprogramme.  Equal‐Lifeoutcomesandhealthequity(INCHES) Interactivesessionwithmentimeteronquestionsrelatedtodatacollectionandvulnerability.See resultsinannex13. Question1:Therearedatacollectionplans.Howcanweconnectdataonphysicalexposuresto knowledgeaboutwhatworksforchildren’smentalhealth? Multiplechoiceanswers 72  ‐ DataCollectionandIntegrationofdata ‐ InterdisciplinaryCollaboration ‐ LongitudinalStudies ‐ CausalPathwaysandMechanisms ‐ CommunityEngagement ‐ Other Result:Therearedatacollectionplans.Howcanweconnectdataonphysicalexposurestoknowledge aboutwhatworksforchildren’smentalhealth?Highestrankfor‘interdisciplinarycollaboration’ followedby‘datacollectionandintegrationofdata’.Suggestion:mapdataownersanddatasources inordertomakesenseofcombinationsofdataandtomakeastoryonthedata.  RelatedtoVulnerability Thefollowingtwoquestionswerebasedonsomehomeworkonatextofvulnerabilities(fromWP1). Question2:Whichdimensionofvulnerabilitydoyouthinkwillcausemostimpactonchildren’s mentalhealth?(oneanswerpossible) ‐ Differentialexposure ‐ Differentialsusceptibility ‐ Differentiationincapacity ‐ Other  Result:Whichdimensionofvulnerabilitydoyouthinkwillcausemostimpactonchildren’smental health?Highestrankedansweris‘differentialsusceptibility’.Alternativeanswercategories: environmentalexposuresandpreventiveinterventions. Note:theusedtermsarequitedifficulttounderstand. Question3:Whichdimensionofvulnerabilityprovidesthebestopportunityforpolicyaction? (oneanswerpossible) ‐ Differentialexposure ‐ Differentialsusceptibility ‐ Differentiationincapacity ‐ Other Result:Highestrankingansweris‘differentialexposures’. ThefinalquestionwasrelatedtoTransdisciplinaryinteraction. Improvingtransdisciplinarycooperationinpolicydevelopmentrequiresathoughtfulandstrategic approachtobreakingdownsilos,fosteringcollaboration,andintegratingdiverseperspectives. Transdisciplinarycooperationinvolvesworkingacrossmultipledisciplinesandstakeholderstoaddress complexissuesandcreatewell‐roundedpolicies. Question4 Whichapproachwillenhancetransdisciplinaryinteractioninyourviewmost? Multiplechoiceanswers(moreanswerspossible), 73  ‐ SharedVisionandGoals ‐ DiverseStakeholderEngagement ‐ EffectiveCommunication ‐ InterdisciplinaryTraining ‐ IntegratedResearchandDataSharing ‐ Other Result:Highestrankingansweris‘effectivecommunication’,followedby‘diversestakeholder engagement’and‘interdisciplinarytraining’. Wrap‐upandconclusions(INCHESandCoU) Actionsandnextsteps: - Stakeholderreviewinanalysesandreporting - Broadeningparticipation/stakeholderengagementfromvariousdisciplines - Policyrecommendations - Storytelling - Socialmediaplan/disseminationplan - Training - Nextmeetingtobescheduled:earlyJune2024,possiblelocationsCork,Ghentor Leipzig  Inconclusion:ThecollaborativeeffortswithinWorkPackage8(WP8togetherwithWP9)haveyielded substantialprogressinshapinganddevelopingideasforpolicydevelopment,thetoolboxand guidebook.Eachtaskwasexecutedinasynergisticmanner,resultinginaprototypeofthesemantic explorationandknowledgetoolsthatwaspresentedtostakeholdersinHelsinki.This,alongsideactive participationinstakeholderworkshopsandjointendeavorswithWP9,bolsteredstakeholder engagementandenrichedprojectresources.   80  Which dimension of vulnerability do you think will cause most impact on children’s mental health?  81  Which dimension of vulnerability provides the best opportunity for policy action?  82  Which approach will enhance transdisciplinary interaction in your view most?  Annex14researchquestionsusedinComoco‐designworkshop  Researchquestions Session3.Topic:Researchquestions  Theaimofthissessionisfocusontheuseofourresearchresultstotheworldofpolicymaking.  Therefore,wewouldliketoaskyoutodosomehomeworkbeforethemeetinginComo.  Wehavearangeofresearchquestions. Table1showsanoverviewofexternalexposomequestionsinassociationwithcognitiveandmentalhealthoutcomes.Theseareoverarchingresearch questions.  Table2showstheoutlineforalistofquestionsfocusingonacombinationofselectedexposures(externalandinternal).Thesequestionsarealsoanticipatedas overarchingresearchquestions.Inthislistofquestions,thereare7corequestionswhicharethenrepeatedforthe9differentoutcomesthatareofinterestin Equal‐Life.Thesetargetedquestionsaimtoconsiderboththecumulativeeffectsandthelife‐courseperspectiveinanalysingtheeffectsofdifferent combinationsofexposuresonmentalhealthandcognitiveoutcomes.Thetargetedanalysiswillalsoincludemediators,modifiersandre‐reversedcausality(bi‐ directional)analyses.  84  InadditiontothemainresearchquestionsinEqual‐Life,inTable3,wehavegatheredquestionsthatarespecifictostudyingtheassociationsbetweendiverse typesofexposomes(e.g.,socialexposome,physicalexposome).  Ashomeworkwewouldliketoaskyoutochooseforeachtablethethreequestionsthatyouconsiderthemostrelevant. Youmayhavespecificcriteriathatsupportyourdecision.Pleasetakenoteofyourargumentstoselectyourpreferencequestions. Youmightconsiderargumentsbasedonfeasibilitytomakeinterventions,onthebiggesthealthimpact,oncost‐benefitreasons,onsupportingcurrent projects,oranyotherreason.Youalsohaveargumentswhysomeresearchquestionsarenotgood,notfeasibleormaybenotjustorethical. Doyouconsiderresearchquestionsassucharevaluableforstakeholderslikepolicymakersoronlytheresults?  CanyoubringyourfilledinformstoComo. However,wepreferitifyoucouldsendusyourfilledinformstwodaysbeforesowecanprintthemout.  InthesessionrelatedtotheEqual‐Lifequestionswewilldiscussyourfeedbackontheresearchquestions. 85    86     87    88   89   96    97    98    99    100    101   102    103    104   105   